den Dulk K, Lindemans F W, Wellens H J
Am J Cardiol. 1984 Feb 1;53(4):537-43. doi: 10.1016/0002-9149(84)90027-4.
Ventriculoatrial (VA) conduction was studied in 11 patients before DDD pacemaker implantation by incremental right ventricular pacing while recording right atrial endocavitary signals. After implantation and at 3-month outpatient visits, VA conduction and ability to initiate and sustain pacemaker circus movement tachycardia (PCMT) were systematically assessed noninvasively by testing the response of the pacemaker to asynchronous and single synchronized chest wall stimuli, muscle signals, and programmer pertubations. VA conduction was demonstrated in 3 of 11 patients before implantation as well as by noninvasive techniques after implantation with induction of PCMT. VA conduction became apparent in 2 additional patients after implantation. One of the 2 patients presented clinically with PCMT. In both patients, PCMT could be induced noninvasively. The presence or absence of VA conduction was variable, as was the rate of right ventricular pacing at which VA block occurred. In conclusion, (1) noninvasive testing techniques were effective in inducing PCMT in all patients with VA conduction and helpful in determining control of PCMTs, and (2) thorough preimplantation and repeated postimplantation assessment is needed to control and prevent PCMT.
在11例患者植入DDD起搏器前，通过递增性右心室起搏并记录右心房心腔内信号，对房室传导进行了研究。植入后及3个月门诊随访时，通过测试起搏器对异步和单次同步胸壁刺激、肌肉信号及程控干扰的反应，对房室传导以及引发和维持起搏器折返性心动过速（PCMT）的能力进行了系统的无创评估。植入前11例患者中有3例存在房室传导，植入后通过无创技术并诱发PCMT也证实了房室传导。植入后又有2例患者出现明显的房室传导。其中1例患者临床上表现为PCMT。在这2例患者中，均可无创诱发PCMT。房室传导的有无是可变的，发生房室阻滞时的右心室起搏频率也是如此。总之，（1）无创检测技术对所有存在房室传导的患者诱发PCMT有效，且有助于确定对PCMT的控制，（2）需要进行全面的植入前和反复的植入后评估以控制和预防PCMT。
