典型房室结折返性心动过速(AVNRT)的表面心电图显示,V1中同时存在假R\'的心室-心房(RP)激活,典型心率范围为150至220/min。较低的速率对于交界性心动过速(JT)是可疑的。然而,偶尔我们会遇到典型的AVNRT伴缓慢心室率。我们描述了一系列典型的AVNRT病例,心率低于110/min。
对1972例接受慢径路消融的房室结折返性心动过速患者进行分析。典型的AVNRT被诊断为:(1)房室结双重传导的证据,(2)通过心房-His-心房反应的心房驱动列车引发心动过速,(3)室间隔时间短,和(4)心室-心房-心室(V-A-V)对心室超速(VOD)起搏的反应,其中校正的起搏后间期-心动过速周期长度(cPPI-TCL)>110ms。通过心房刺激(AES)或心房过度驱动(AOD)起搏终止或推进心动过速,排除了JT。
我们发现了11名患者(年龄20-78岁,6名女性)符合上述标准。TCL的范围为560至782ms。除了一名患者出现心动过速终止,所有患者在VOD的110ms内表现出V-A-V反应和cPPI-TCL。AES或AOD起搏通过在10名患者中推进心动过速或在一名患者中终止心动过速成功排除了JT。慢速通路被成功消融,所有患者均未诱发心动过速。
本病例系列描述了典型AVNRT伴缓慢心室率(小于110/min)的患者,这些患者可能模仿JT。我们强调使用起搏动作排除JT的重要性。
The surface electrocardiography of typical atrioventricular nodal reentrant tachycardia (AVNRT) shows simultaneous ventricular-atrial (RP) activation with pseudo R\' in V1 and typical heart rates ranging from 150 to 220/min. Slower rates are suspicious for junctional tachycardia (JT). However, occasionally we encounter typical AVNRT with slow ventricular rates. We describe a series of typical AVNRT cases with heart rates under 110/min.
A total of 1972 patients with AVNRT who underwent slow pathway ablation were analyzed. Typical AVNRT was diagnosed when; (1) evidence of dual atrioventricular nodal conduction, (2) tachycardia initiation by atrial drive train with atrial-His-atrial response, (3) short septal ventriculoatrial time, and (4) ventricular-atrial-ventricular (V-A-V) response to ventricular overdrive (VOD) pacing with corrected post pacing interval-tachycardia cycle length (cPPI-TCL) > 110 ms. JT was excluded by either termination or advancement of tachycardia by atrial extrastimuli (AES) or atrial overdrive (AOD) pacing.
We found 11 patients (age 20-78 years old, six female) who met the above-mentioned criteria. The TCL ranged from 560 to 782 ms. Except for one patient showing tachycardia termination, all patients demonstrated a V-A-V response and cPPI-TCL over 110 ms with VOD. AES or AOD pacing successfully excluded JT by either advancing the tachycardia in 10 patients or by tachycardia termination in one patient. Slow pathway was successfully ablated, and tachycardia was not inducible in all patients.
This
case series describes patients with typical AVNRT with slow ventricular rate (less than 110/min) who may mimic JT. We emphasize the importance of using pacing maneuvers to exclude JT.