Sellers T D, Gallagher J J, Cope G D, Tonkin A M, Wallace A G
Eur J Cardiol. 1976 Sep;4(3):283-94.
In 34 successive patients with Wolff-Parkinson-White syndrome premature beats were induced from the right ventricular apex during reciprocating tachycardia (RT) at progressively shorter coupling intervals. The presence of an accessory pathway was confirmed by a reduction in the atrial cycle length (A-A interval) during which the premature ventricular beat was introduced. This retrograde preexcitation occurred at a time when the His-AV node pathway was refractory; i.e. there was premature activation of the atria over a pathway other than the His-AV node. 3 patients were excluded because of unsatisfactory or unstable H-H intervals. In the remaining 31 patients with constant preceding H-H intervals, the A-A interval shortened; (a) 35-65 msec in 4 patients with right-sided pathways and normal conduction during RT and by 110 msec in a 5th patient with a right-sided pathway, in whom bundle branch block aberration persisted during RT, (b) 45 msec in the single patient with both a right-sided and a septal accessory pathway, (c) 35-65 msec in 5 patients with septal pathways, and (d) 15-35 msec in only 4/20 patients with left-sided pathways and normal conduction during RT. Left-sided ventricular premature beats were introduced in 5 patients with left-sided pathways and normal conduction in RT. In 4/5, left-sided premature beats shortened the A-A interval 40-75 msec whereas right-sided premature beats at the same coupling interval failed to do so. In the fifth case, the left-sided premature resulted in a 65 msec abbreviation of the A-A interval compared to 30 msec from the right ventricular outflow tract and 15 msec from the right ventricular apex. In 5 patients with left-sided pathways, right ventricular premature beats were introduced during RT with left bundle branch block aberration, and shortened the A-A interval 30-50 msec in all of these, whereas right-sided premature beats in 4 of the 5 during normal conduction failed to do so. This technique is useful to confirm the participation of accessory pathways in reciprocating tachycardias associated with the preexcitation syndromes, and emphasizes the importance of the site of stimulation used relative to the location of the accessory pathway. Because of the possibility of multiple accessory pathways, stimulation of the left ventricle should be performed in patients undergoing surgery for preexcitation unless the left ventricle is already inplicated by right-sided studies.
在34例连续性预激综合征患者中，在折返性心动过速（RT）期间，从右心室心尖部以逐渐缩短的联律间期诱发早搏。通过引入室性早搏时心房周期长度（A-A间期）的缩短来证实旁路的存在。这种逆行性预激发生在希氏束-房室结通路不应期时；即心房通过希氏束-房室结以外的通路提前激动。3例患者因希氏束-希氏束（H-H）间期不满意或不稳定而被排除。在其余31例H-H间期恒定的患者中，A-A间期缩短；（a）4例右侧旁路且RT期间传导正常的患者缩短35 - 65毫秒，第5例右侧旁路患者在RT期间束支阻滞差异持续存在，缩短了110毫秒，（b）1例同时有右侧和间隔旁路的患者缩短45毫秒，（c）5例间隔旁路患者缩短35 - 65毫秒，（d）仅4/20例左侧旁路且RT期间传导正常的患者缩短15 - 35毫秒。5例左侧旁路且RT期间传导正常的患者引入了左心室早搏。在其中4/5例中，左侧早搏使A-A间期缩短40 - 75毫秒，而相同联律间期的右侧早搏则未使其缩短。在第5例中，左侧早搏使A-A间期缩短65毫秒，而右心室流出道早搏使其缩短30毫秒，右心室心尖部早搏使其缩短15毫秒。5例左侧旁路患者在RT期间伴左束支阻滞差异时引入右心室早搏，所有这些患者的A-A间期均缩短30 - 50毫秒，而5例中的4例在正常传导时的右侧早搏则未使其缩短。该技术有助于证实旁路参与与预激综合征相关的折返性心动过速，并强调相对于旁路位置所使用的刺激部位的重要性。由于可能存在多条旁路，对于接受预激手术的患者，除非左侧心室已被右侧研究证实受累，否则应进行左心室刺激。
