Abe H, Fujita M, Ohkita T, Kuroiwa A
Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu City, Japan.
Jpn Heart J. 1993 Jan;34(1):109-15. doi: 10.1536/ihj.34.109.
A 52-year-old man had suffered from attacks of palpitation for 10 years. The frequency of the attacks had been increasing since June 1991. The electrocardiogram (ECG) at the time of attack showed a heart rate of 175 bpm and RP'/P'R > 1, indicating long RP' tachycardia. Electrophysiological examination of the heart revealed an accessory pathway in the left lateral position. During the tachycardia, PVCs from the right ventricular apex (RVA) captured the atria. On the basis of these findings the patient was diagnosed as having had atrioventricular (AV) reciprocating tachycardia (AVRT). Ventriculoatrial (VA) conduction indicated a decremental conduction curve by single premature stimulation from the RVA, and the atrial cycle length following PVC during tachycardia was prolonged (paradoxical delay). When verapamil was administered intravenously, tachycardia induced by the premature stimulation showed prolongation of the VA interval, associated with an increased tachycardia cycle length. Tachycardia in this patient was completely controlled by administration of verapamil.
一名52岁男性心悸发作10年。自1991年6月以来发作频率不断增加。发作时心电图显示心率为175次/分钟，RP'/P'R>1，提示长RP'心动过速。心脏电生理检查发现左侧有一条旁路。心动过速发作时，来自右心室尖部（RVA）的室性早搏（PVC）夺获心房。基于这些发现，该患者被诊断为房室（AV）折返性心动过速（AVRT）。室房（VA）传导通过RVA单次早搏刺激显示递减传导曲线，心动过速发作时PVC后的心房周期长度延长（反常延迟）。静脉注射维拉帕米时，早搏刺激诱发的心动过速显示VA间期延长，同时心动过速周期长度增加。该患者的心动过速通过维拉帕米治疗得到完全控制。
