Josephson M E, Miller J M
Department of Medicine, University of Pennsylvania, Philadelphia.
Pacing Clin Electrophysiol. 1993 Mar;16(3 Pt 2):599-614. doi: 10.1111/j.1540-8159.1993.tb01632.x.
The exact site of the reentrant circuit in AV nodal reentry remains controversial. While recent ablative techniques have yielded information, the interpretation of which suggests that the atrium is required, other explanations for these interpretations are available. Prior pathophysiological studies with three-dimensional reconstruction of the node suggest that it is a highly anisotropic structure and extends through Koch's Triangle. Data from humans suggesting the atria are not necessary include the presence of AV dissociation during supraventricular tachycardia (SVT), depolarization of atrial tissue surrounding the node without affecting SVT, pacing induced AH intervals exceeding those during SVT, and site dependency of a critical AH interval (exceeding atrial refractoriness) that is required for initiation of AV nodal reentry.
房室结折返性心动过速中折返环路的确切部位仍存在争议。虽然近期的消融技术已得出相关信息，其解读表明心房是必需的，但对这些解读也有其他解释。先前对房室结进行三维重建的病理生理学研究表明，它是一个高度各向异性的结构，延伸穿过科赫三角。来自人体的数据表明心房并非必需，这些数据包括室上性心动过速（SVT）期间存在房室分离、结周围心房组织去极化但不影响SVT、起搏诱发的AH间期超过SVT期间的AH间期，以及启动房室结折返所需的关键AH间期（超过心房不应期）的部位依赖性。
