Dhatt M S, Akhtar M, Reddy P, Gomes J A, Lau S H, Caracta A R, Damato A N
Circulation. 1977 Nov;56(5):720-6. doi: 10.1161/01.cir.56.5.720.
The phenomenon of macrore-entry (Re) within the His-Purkinje system (HPS) was consistently observed in 10 of 19 patients during retrograde refractory period studies. Effects of intravenous infusion of diphenylhydantoin (DPH) on Re were studied in these 10 patients 10 minutes after completion of infusion (mean plasma level equal to 17.0 microgram/ml). Diphenylhydantoin modified determinants of Re in seven patients (group I) and abolished Re in the remaining three patients (group II). In group I, DPH shortened the critical V1 V2 from 310.0 +/- 30.5 to 292.9 +/- 25.6 msec (P less than 0.025) and critical V2 H2 intervals for Re from 201.4 +/- 18.4 to 185.0 +/- 13.8 msec (P greater than 0.05). In group II, DPH abolished Re in two of three patients by precluding attainment of critical V2 H2 intervals whereas Re was abolished in the remaining one patient despite attainment of critical V2 H2 intervals (vs control). For both groups, DPH significantly shortened functional and effective refractory periods of the HPS (P less than 0.001 and less than 0.01, respectively) without significantly affecting the effective refractory period of the ventricular muscle. Diphenylhydantoin either completely abolished or significantly shortened the retrograde gap zones in the HPS. It is concluded that diphenylhydantoin significantly shortens His-Purkinje system refractoriness, abolishing Re in the patients with higher degree of improvement in refractoriness.
在19例患者的逆行不应期研究中，有10例持续观察到希氏-浦肯野系统（HPS）内的大折返（Re）现象。在这10例患者输注完成10分钟后（平均血浆水平等于17.0微克/毫升），研究了静脉输注苯妥英（DPH）对Re的影响。苯妥英改变了7例患者（I组）Re的决定因素，并消除了其余3例患者（II组）的Re。在I组中，DPH将Re的临界V1 V2从310.0±30.5毫秒缩短至292.9±25.6毫秒（P<0.025），将Re的临界V2 H2间期从201.4±18.4毫秒缩短至185.0±13.8毫秒（P>0.05）。在II组中，DPH通过阻止达到临界V2 H2间期消除了3例患者中的2例的Re，而在其余1例患者中，尽管达到了临界V2 H2间期（与对照组相比），Re仍被消除。对于两组，DPH均显著缩短了HPS的功能和有效不应期（分别为P<0.001和<0.01），而对心室肌的有效不应期无显著影响。苯妥英要么完全消除要么显著缩短了HPS中的逆行间隙区。结论是，苯妥英显著缩短希氏-浦肯野系统的不应期，在不应期改善程度较高的患者中消除Re。
