Wen Z C, Chen S A, Tai C T, Chiang C E, Chiou C W, Chang M S
Division of Cardiology, Department of Medicine, National Yang-Ming University, School of Medicine, and Veterans General Hospital-Taipei, Taiwan.
Circulation. 1998 Dec 15;98(24):2716-23. doi: 10.1161/01.cir.98.24.2716.
The vagal maneuvers used for termination of paroxysmal supraventricular reentrant tachycardia (PSVT) appear to involve more complex mechanisms than we have known, and further study should be done to explore the possible mechanisms.
In this study, 133 patients with PSVT and 30 age- and sex-matched control subjects were included. We assessed the effects of different vagal maneuvers on termination of PSVT and compared baroreflex sensitivity and beta-adrenergic sensitivity between the patients with PSVT and control subjects. Out of 85 patients with atrioventricular reciprocating tachycardia (AVRT), vagal maneuvers terminated in 45 (53%). Of these, 28 (33%) terminated in the antegrade limb and 17 (20%) terminated in the retrograde limb. Out of 48 patients with atrioventricular nodal reentrant tachycardia (AVNRT), vagal maneuvers terminated the tachycardia in the antegrade slow pathway (14%) or in the retrograde fast pathway (19%). Baroreflex sensitivity was poorer but isoproterenol sensitivity test better in patients with AVNRT. Poorer antegrade atrioventricular node conduction properties and better vagal response determined successful antegrade termination of AVRT by vagal maneuvers. Poorer retrograde accessory pathway conduction property but better vagal response determined successful retrograde termination of AVRT. Better sympathetic and vagal response associated with poorer retrograde atrioventricular node conduction determined retrograde termination of AVNRT by the Valsalva maneuver.
Both the vagal response and conduction properties of the reentrant circuit determine the tachycardia termination by vagal maneuvers. Improved understanding of the interaction of autonomic and electrophysiological mechanisms in maintaining or terminating PSVT may provide important insight into the pathophysiology of these two tachycardias.
用于终止阵发性室上性折返性心动过速（PSVT）的迷走神经刺激法似乎涉及比我们已知更为复杂的机制，应进一步开展研究以探索其可能机制。
本研究纳入了133例PSVT患者以及30例年龄和性别匹配的对照受试者。我们评估了不同迷走神经刺激法对PSVT终止的影响，并比较了PSVT患者与对照受试者之间的压力反射敏感性和β-肾上腺素能敏感性。在85例房室折返性心动过速（AVRT）患者中，迷走神经刺激法使45例（53%）终止发作。其中，28例（33%）在前向支终止，17例（20%）在逆向支终止。在48例房室结折返性心动过速（AVNRT）患者中，迷走神经刺激法在前向慢径路（14%）或逆向快径路（19%）终止心动过速。AVNRT患者的压力反射敏感性较差，但异丙肾上腺素敏感性试验较好。前向房室结传导特性较差但迷走神经反应较好决定了迷走神经刺激法能成功前向终止AVRT。逆向旁道传导特性较差但迷走神经反应较好决定了迷走神经刺激法能成功逆向终止AVRT。较好的交感神经和迷走神经反应以及较差的逆向房室结传导决定了Valsalva动作能逆向终止AVNRT。
迷走神经反应和折返环路的传导特性均决定了迷走神经刺激法对心动过速的终止作用。更好地理解自主神经和电生理机制在维持或终止PSVT中的相互作用，可能为这两种心动过速的病理生理学提供重要见解。
