Wu T J, Chen S A, Chiang C E, Yang C J, Cheng C C, Wang S P, Chiang B N, Chang M S
Department of Medicine, Veterans General Hospital-Taipei, Taiwan, R.O.C.
Jpn Heart J. 1994 Jul;35(4):431-42. doi: 10.1536/ihj.35.431.
Reverse alternating Wenckebach periods (RAWP) have rarely been described, and the significance of dual AV nodal pathways in atrial pacing-induced RAWP is unknown. Forty-five of 50 consecutive patients (M/F = 23/27, mean age 40 +/- 5 years) with common type AV nodal reentrant tachycardia had discontinuous antegrade conduction curves. Atrial pacing revealed that pattern A RAWP (23 patients) had the fourth paced beat conducted over the fast pathway, and pattern B (18 patients) over the slow pathway. Four patients had both pattern A and B RAWP during different pacing cycle lengths. All episodes of atrial pacing-induced RAWP emerged from (or started as) 3:2 AH block, which thereafter were followed by runs of 2:1 AH block. Comparisons between patterns A and B showed (1) maximal atrial pacing cycle length with RAWP was longer in pattern A; (2) A2H2-A1H1 and A4H4-A1H1 were significantly greater in pattern B; (3) A2H2-A4H4 and H2A4/A2H2 were significantly greater in pattern A. It is concluded that atrial pacing-induced RAWP is a common electrophysiologic phenomenon in patients with dual AV nodal pathways. Furthermore, intermittent slow pathway conduction associated with different AnHn and HnAn+2 parameters helped the interpretation of different conduction patterns.
逆向交替文氏周期（RAWP）鲜有报道，且房室结双径路在心房起搏诱发RAWP中的意义尚不清楚。50例连续性常见类型房室结折返性心动过速患者中，45例（男/女 = 23/27，平均年龄40±5岁）存在不连续的前向传导曲线。心房起搏显示，A 型RAWP（23例患者）中第4次起搏搏动经快径路传导，B型（18例患者）经慢径路传导。4例患者在不同起搏周期长度时同时出现A型和B型RAWP。所有心房起搏诱发的RAWP发作均始于3∶2 房室传导阻滞，随后出现2∶1 房室传导阻滞。A型和B型的比较显示：（1）出现RAWP时的最大心房起搏周期长度，A型更长；（2）B型的A2H2 - A1H1和A4H4 - A1H1显著增大；（3）A型的A2H2 - A4H4和H2A4/A2H2显著增大。结论为，心房起搏诱发的RAWP是房室结双径路患者常见的电生理现象。此外，与不同的AnHn和HnAn+2参数相关的间歇性慢径路传导有助于解释不同的传导模式。
