Weismüller P, Thamasett S, Grossmann G, Wierse G, Hombach V
Abteilung Innere Medizin II (Kardiologie, Angiologie, Pneumologie, Nephrologie) Universitt Ulm.
Z Kardiol. 1996 Dec;85(12):949-52.
A 52-year-old man with frequent episodes of narrow QRS complex tachycardias with rates of 150/min was admitted for electrophysiological evaluation and treatment. P waves could be seen in the ST-segment of the surface ECG during tachycardia. Atrial stimulation during electrophysiological testing was not able to induce tachycardia. During atrial stimulation, there was no evidence of conduction via an accessory pathway or of dual AV node conduction properties. Ventricular stimulation showed complete ventriculoatrial block. After intravenous administration of the catecholamine orciprenaline, single atrial extrastimuli induced an AV macro-reentrant tachycardia with a rate of 165/min. VA conduction showed the earliest retrograde atrial activation in the left anterolateral area. Thus, there was an accessory pathway which only conducted in ventriculoatrial direction and only during adrenergic stimulation. After successful radiofrequency catheter ablation, complete ventriculoatrial block was recorded even after repeat administration of orciprenaline during ventricular stimulation. This case confirms the need to administer catecholamines in every undiagnosed tachycardia during electrophysiological testing to reveal the mechanism of the tachycardia.
一名52岁男性，频繁发作窄QRS波群心动过速，心率为150次/分钟，因电生理评估和治疗入院。心动过速时体表心电图ST段可见P波。电生理检查期间的心房刺激未能诱发心动过速。心房刺激期间，没有证据表明存在经旁路传导或房室结双径路传导特性。心室刺激显示完全室房阻滞。静脉注射儿茶酚胺奥西那林后，单个心房期外刺激诱发了心率为165次/分钟的房室大折返性心动过速。室房传导显示最早的逆向心房激动位于左前外侧区域。因此，存在一条仅在室房方向传导且仅在肾上腺素能刺激时传导的旁路。成功进行射频导管消融后，即使在心室刺激期间重复给予奥西那林，仍记录到完全室房阻滞。该病例证实了在电生理检查期间对每一例未确诊的心动过速使用儿茶酚胺以揭示心动过速机制的必要性。
