Castellanos A, Sung R J, Berkovits B V, Alatriste V M, Myerburg R J
Chest. 1978 Sep;74(3):274-9. doi: 10.1378/chest.74.3.274.
Atrioventricular nodal alternating Wenckebach periods ending in 5:1 atrioventricular block occurring during rapid atrial rhythms were explained by postulating the presence of block in three levels of the atrioventricular node. This pattern of conduction occurred in ten of 11 patients who either had received ouabain or verapamil (nine patients) or who had organic atrioventricular nodal disease (two patients). In contrast, this pattern of conduction occurred in only one of eight nonmedicated patients without organic atrioventricular nodal disease. The frequent association of this pattern with paroxysmal, tachycardia-dependent atrioventtricular nodal block suggested a similar, but not necessarily identical, mechanism. In conclusion, atrioventricular nodal alternating Wenckebach periods ending in 5:1 atrioventricular block, as well as paroxysmal atrioventricular nodal block, were only rarely the result of rapid atrial rates per se their occurrence indicating organic or pharmacologic effects on the atrioventricular node. Since both can be produced by carotid sinus pressure, further studies appear to be necessary to determine the role that vagal effects can have in their genesis.
在快速房性心律期间出现的以5:1房室传导阻滞告终的房室结交替性文氏周期，通过假设房室结三个水平存在阻滞来解释。这种传导模式发生在11例患者中的10例，这些患者要么接受过哇巴因或维拉帕米治疗（9例患者），要么患有器质性房室结疾病（2例患者）。相比之下，这种传导模式仅发生在8例无器质性房室结疾病的未用药患者中的1例。这种模式与阵发性、心动过速依赖性房室结阻滞的频繁关联提示了一种相似但不一定相同的机制。总之，以5:1房室传导阻滞告终的房室结交替性文氏周期以及阵发性房室结阻滞，很少是快速房率本身的结果，它们的出现表明对房室结有器质性或药物性影响。由于两者都可由颈动脉窦按压产生，似乎有必要进一步研究以确定迷走神经效应在其发生过程中可能起的作用。
