Pandozi C, Castro A, Toscano S, Villani M, Santini M
Dipartimento delle Malattie del Cuore, Ospedale S. Fillippo Neri, Roma.
G Ital Cardiol. 1996 Jul;26(7):793-802.
Bundle branch reentry tachycardia has been reported in patients with left ventricular dilatation, especially in those with dilated cardiomyopathy and aortic regurgitation. These patients show aspecific intraventricular conduction delay on the ECG and a prolonged H-V interval at the electrophysiologic study. We report 2 cases of bundle branch reentry tachycardia in patients without left ventricular enlargement to help the correct diagnosis of the arrhythmia. A correct diagnosis is very important because bundle branch reentry tachycardia is easily and safely treated by right bundle transcatheter radiofrequency ablation. We also report electrophysiologic characteristics we found during the study and the ablation: -contrary to the data reported in literature, at ventricular tachycardia starting, modifications of the V-V interval are not always preceded by similar variations in the H-H interval. -during right bundle radiofrequency ablation, a QRS narrowing may precede right bundle branch block appearance. This QRS normalisation should induce to continue and not to stop energy delivering.
束支折返性心动过速已在左心室扩张的患者中被报道,尤其是那些患有扩张型心肌病和主动脉瓣反流的患者。这些患者在心电图上表现为非特异性室内传导延迟,在电生理研究中表现为H-V间期延长。我们报告2例无左心室扩大的束支折返性心动过速患者,以帮助正确诊断这种心律失常。正确的诊断非常重要,因为束支折返性心动过速通过右束支导管射频消融术易于且安全地治疗。我们还报告了在研究和消融过程中发现的电生理特征:与文献报道的数据相反,在室性心动过速开始时,V-V间期的改变并不总是先于H-H间期的类似变化。在右束支射频消融期间,QRS波变窄可能先于右束支传导阻滞出现。这种QRS波正常化应促使继续而不是停止能量输送。