Chen I C, Yeh S J, Wen M S, Wang C C, Lin F C, Wu D
Department of Medicine, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan.
J Electrocardiol. 1995 Jul;28(3):253-9. doi: 10.1016/s0022-0736(05)80264-x.
A 38-year-old man with no significant structural heart disease suffered from one episode of wide QRS tachycardia. The electrocardiogram showed a PR interval of 0.20 second and a QRS duration of 0.10 second. His bundle recording revealed an HV interval of 90-100 ms. The tachycardia was inducible with programmed stimulation and displayed a QRS morphology of complete left bundle branch block. It was characterized by an atrioventricular dissociation, a cycle length of 280 ms, and an H deflection preceding each QRS complex. Pacing from the right ventricular apex at a cycle length of 270 ms entrained the tachycardia, while at a cycle length of 260 ms, the tachycardia was terminated. Four years later, the patient presented with complete atrioventricular block with a wide QRS escape rhythm. An electrophysiologic study conducted while he was in 1:1 atrioventricular conduction showed an HV interval of 100 ms. Second-degree infrahisian block developed at an atrial paced cycle length of 700 ms. There was no induction of tachycardia with programmed stimulation before or after isoproterenol. The patient was treated with an implantation of a permanent pacemaker.
一名38岁无明显结构性心脏病的男性发生了一次宽QRS心动过速。心电图显示PR间期0.20秒，QRS时限0.10秒。他的希氏束记录显示HV间期为90 - 100毫秒。心动过速可通过程序刺激诱发，呈现完全性左束支传导阻滞的QRS形态。其特征为房室分离，周长280毫秒，每个QRS波群前有H波。以270毫秒的周长从右心室尖部起搏可拖带心动过速，而以260毫秒的周长起搏时，心动过速终止。四年后，患者出现完全性房室传导阻滞伴宽QRS逸搏心律。在1:1房室传导时进行的电生理研究显示HV间期为100毫秒。在心房起搏周长为700毫秒时出现二度希氏束下阻滞。在异丙肾上腺素前后进行程序刺激均未诱发心动过速。患者接受了永久性起搏器植入治疗。
