阵发性室上性心动过速的特殊电生理现象

SPECIAL ELECTROPHYSIOLOGIC PHENOMENA IN PAROXYSMAL SUPRAVEN- TRICULAR TACHYCARDIA: Report Of Four Cases

报告具有特殊电生理现象的阵发性室上性心动过速4例,分别为:房室结内折返性室上速合并隐匿性类James传导束;具有右侧旁道的预激症状群患者,出现逆行的房室间折返性室上速,心电图与室性心动过速难以区别;在房室结内或其附近有双重折返圈;具有两条隐匿性旁道,分布在左室游离壁和室间隔,但均以正常房室通道为前传径路。讨论了这些特殊电生理机理的临床意义。

Four cases of reentrant paroxysmal supraventricular tachycardia (PSVT) with special electrophy-siologic features were reported. The first case, a 70-year-old female who sustained frequent episodes of tachycardia was found, except intra-AV nodal reentry, to have a concealed AV conduction tract behaving like the James tract but inserting into the distal his bundle. The second patient was a 50-year-old woman who had been treated previously as ventricular tachycardia. Electrophysiologic examination proved to be antidromic atrioventricular reentrant SVT, incorporating a right side bypass tract. The third was 50-year-old male with history of hypertension and CAD, whose frequent attacks of tachycardia were due to double reentrant circuits located in AV node or its heart neighborhood. The fourth patient, a 34-year-old young woman, had suffered from troublesome tachycardia for 3 years. Programmed atrial stimulation yielded two types of SVT, using different concealed bypass tracts, one of which on the left side and the other at the AV junction, sharing normal AV system as their antegrade conduction during SVT.The practical significance of elucidation of the mechanism of these electrophysiologic changes in the diagnosis and treatment of refractory paroxysmal supraventricular tachycardia was briefly discussed.