Motté G, Dinanian S, Sebag C, Drieu L, Slama M
Faculté de médecine Paris-Sud, Hôpital Antoine-Béclère, Clamart.
Arch Mal Coeur Vaiss. 1995 Dec;88 Spec No 5:11-8.
Double response is a rare electrocardiographic phenomenon requiring two atrioventricular conduction pathways with very different electrophysiological properties. Double ventricular responses are the usual manifestation: an atrial depolarisation (spontaneous or provoked, anticipated or not) is followed by a first ventricular response dependent on an accessory pathway or a rapid nodal pathway and then a second response resulting from sufficiently delayed transmission through a nodal pathway for the ventricles to have recovered their excitability when the second wave of activation reaches them. A simple curiosity when isolated and occurring under unusual conditions, particularly during electrophysiological investigation of the Wolff-Parkinson-White syndrome, the double response may initiate symptomatic non-reentrant junctional tachycardia when associated with nodal duality and repeating from atria in sinus rhythm. The functional incapacity and resistance to antiarrhythmic therapy may require referral for ablation of the slow pathway.
双反应是一种罕见的心电图现象,需要两条具有截然不同电生理特性的房室传导途径。双心室反应是常见表现:心房去极化(自发或诱发、预期或非预期)之后是依赖于旁路或快速结径路的首次心室反应,然后是由于通过结径路的传导充分延迟,使得当第二次激动波到达心室时心室已恢复其兴奋性而产生的第二次反应。双反应在孤立且在不寻常情况下出现时,尤其是在预激综合征的电生理检查期间,只是一种单纯的奇事,但当与结双径路相关且在窦性心律时从心房反复出现时,可能引发有症状的非折返性交界性心动过速。其功能障碍及对抗心律失常治疗的抵抗可能需要转诊进行慢径路消融。