背景:隐匿性结室/结束(NV/NF)通路主要是旁观者,逆行旁路连接右心室/右束支(RBB)和慢路(SP),在房室结折返性心动过速(AVNRT)患者中观察到。然而,其患病率和响应起搏动作的特征尚未得到充分评估.
目的:本研究调查了具有旁观者NV/NF通路的AVNRT的患病率和特征。
方法:我们回顾性分析了153例接受AVNRT导管消融术的患者。排除52例电生理数据不足的患者,101名患者构成了研究人群。
结果:3例患者(3.0%)有旁观隐藏的NV/NF通路,所有这些都连接到SP。2例心动过速为典型的SP/fast途径(FP)AVNRT,1例不典型的FP/SPAVNRT。在所有情况下,His难治性心室额外刺激(VES)通过NV/NF通路延迟重置AVNRT。早期心室超速起搏(VOP)也会延迟重置AVNRT。较早的VES和VOP的中期没有重置心动过速,进一步早期的VES和晚期的VOP通过RBB-His传导提前重置心动过速。
结论:在AVNRT患者中,旁观者NV/NF通路并不罕见。具有旁观者NV/NF通路的AVNRT的VESs和VOP的特征在于两相复位现象:通过NV/NF通路延迟的初始瞬时复位,并通过RBB-His传导提前延迟重置。
BACKGROUND: The concealed nodoventricular/nodofascicular (NV/NF) pathway is mostly a bystander, retrograde bypass tract connecting the right ventricle/right bundle branch (RBB) and slow pathway that is observed in patients with atrioventricular nodal reentrant tachycardia (AVNRT). However, its prevalence and characteristics in response to pacing maneuvers have not been fully evaluated.
OBJECTIVE: This study investigated the prevalence and characteristics of AVNRT with a bystander NV/NF pathway.
METHODS: We retrospectively reviewed 153 consecutive patients undergoing catheter ablation of AVNRT. After exclusion of 52 patients with inadequate electrophysiologic data, 101 patients composed the study population.
RESULTS: Three patients (3.0%) had bystander concealed NV/NF pathways, all of which were connected to the slow pathway. The tachycardia was typical slow pathway/fast pathway AVNRT in 2 patients and atypical fast pathway/slow pathway AVNRT in 1 patient. In all cases, His-refractory ventricular extra-stimuli (VES) reset the AVNRTs with delay through the NV/NF pathways. Ventricular overdrive pacing (VOP) in the early phase also reset the AVNRT with delay. Earlier VES and middle phase of VOP did not reset the tachycardia, and further earlier VES and late phase of VOP reset the tachycardia with advance through the RBB-His conduction.
CONCLUSIONS: A bystander NV/NF pathway was not rare in patients with AVNRT. The VES and VOP for the AVNRTs with the bystander NV/NF pathways were characterized by the 2-phase resetting phenomenon: initial transient resetting with delay through the NV/NF pathway, and late resetting with advance through the RBB-His conduction.