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目的:研究窦性冲动沿房室结双径路同时前传导致心动过速的电生理机制,探讨房室结快、慢径同时传导的影响因素。方法:56岁男性患者,室上性心动过速无休止发作,抗心律失常药物无效,心电生理检查明确心律失常性质,射频消融改良房室结。结果:心动过速时,记录食道电图P波后两个QRS波群呈P-QRS1-QRS2型;希氏束电图示A-H1-V1-H2-V2,心房激动沿双径同时前传时快径文氏或高度阻滞、慢径不典型文氏阻滞;心房内电生理刺激诱发出1∶2房室激动现象,呈S-A-H1-V1-H2-V2;快径不应期430 m s,慢径不应期260 m s;房室结区无室房逆传功能。P-P间期≤0.72 s,1∶2房室传导多见。射频消融改良慢径后,心动过速终止,房室传导为1∶1。随访3月未再发作心动过速,心脏结构与功能正常。结论:房室结双径路同时前传窦性冲动引起心动过速为非折返性心动过速。快/慢径前传不应期、传导时间差异及房室结区无室房逆传特性、窦性频率变化可能是窦性冲动能否同时沿双径路前传双重激动心室的影响因素。射频消融可根治此类心律失常。
OBJECTIVE: To study the electrophysiological mechanism of sinus impulse along the dual atrioventricular node pathways and to induce tachycardia, and to explore the influencing factors of simultaneous conduction of atrioventricular node fast and slow pathway. METHODS: A 56-year-old male patient had an intermittent supraventricular tachycardia, an anti-arrhythmic drug, an electrophysiological examination of arrhythmia, and radiofrequency ablation of the atrioventricular node. Results: During tachycardia, two QRS complexes of P wave were recorded as P-QRS1-QRS2 after P-wave; while A-H1-V1-H2- Fast radial Venturi or height block, slow pathway atypical Venturi block; atrial electrophysiology induced 1: 2 atrioventricular activation was SA-H1-V1-H2-V2; fast-track refractory period 430 ms, slow-channel refractory period 260 ms; atrioventricular nodal room without retrograde function. P-P interval ≤ 0.72 s, 1: 2 atrioventricular conduction more common. After radiofrequency ablation improved slow pathway, tachycardia termination, atrioventricular conduction of 1: 1. Follow-up in March did not recurrence of tachycardia, cardiac structure and function of normal. Conclusions: Atrioventricular nodal dual pathway at the same time pre-sent sinus impulses cause tachycardia non-reentrant tachycardia. Fast / slow prefrontal refractory period, conduction time difference and atrioventricular nodal room without retrograde characteristics of sinusoidal frequency changes may be the same time along the dual-channel sinus rhythm of pre-transmission of dual motile ventricular factors. Radiofrequency ablation can cure such arrhythmias.