持续性交界区折返性心动过速的诊断与治疗

持续性交界区折返性心动过速（ｐｅｒｍａｎｅｎｔｊｕｎｃｔｉｏｎａｌｒｅｃｉｐｒｏｃａｔｉｎｇｔａｃｈｙｃａｒｄｉａ,ＰＪＲＴ）是一种临床上并不常见且药物治疗难以奏效的室上性心动过速（ＰＳＶＴ）,既往对它的认识十分有限。近年来,随着心脏电生理研究的不断...     

当今对持续性交接区反复性心动过速的认识

当今对持续性交接区反复性心动过速的认识持续性交接区反复性心动过速（ｐｅｒｍａｎｅｎｔｊｕｎｃｔｉｏｎａｌｒｅｃｉｐｒｏｃａｔｉｎｇｔａｃｈｙｃａｒｄｉａ，ＰＪＲＴ）是Ｃｏｕｍｅｌ于１９６７年首先报告的一种特殊的心动过速。早期工作认为ＰＪＲＴ是不典型...     

房室结三径路伴不典型房室结折返性心动过速的电生理特点及消融体会

房室结三径路伴不典型房室结折返性心动过速（ＡＶＮＲＴ）少见,心内电生理特点复杂,常易误诊为房室折返性心动过速（ＡＶＲＴ）、持续性交界区反复性心动过速（ＰＪＲＴ）、房速等。本文报告两例房室结三径路伴（ＡＶＮＲＴ）的电生理特点及射频消融体会。临床资料　病例１：患者,男,１８岁。阵发性心悸３年,加重半年。发作呈突发突止,数次／日,每次持续数分至数小时不等。查体无阳性体征。平时心电图正常。发作时呈窄ＱＲＳ心动过速,有两种频率：１１０次／分（ｂｐｍ）和１７０ｂｐｍ。食道心电图示室上速（ＳＶＴ）发作时ＶＡ…     

持续性交界区反复性心动过速的研究现状

持续性交界区反复性心动过速的研究现状河南省郑州市心血管病研究所刘怀霖金华综述北京医科大学人民医院郭继鸿审校持续性交界区反复性心动过速（ｐｅｒｍａｎｅｎｔｊｕｎｃｔｉｏｎａｌｒｅｃｉｐｒｏｃａｔｉｎｇｔａｃｈｙｃａｒｄｉａ，ＰＪＲＴ）是临床少见的心律失...     

持续交界性心动过速的电生理特点和射频消蚀治疗

报道５例持续交界性心动过速（ＳＪＲＴ）的电生理特点和射频消蚀（ＲＦＣＡ）治疗。结果表明，５例患者的室房传导和心动过速的逆传支为具有递减传导性能的隐匿性房室旁路（ＡＰ）。电生理特点为：（１）心室刺激与心动过速的逆传心房顺序相同；（２）右室间隔上部刺激的室房传导时间明显短于右室尖部刺激；（３）心动过速时于Ｈ波同步刺激心室可逆传至心房且使之提前激动；（４）４例ＲＦＣＡ成功阻断ＡＰ，３例ＡＰ位于右后隔区，     

射频消融治疗房性心动过速

导管射频消融术（ＲＦＣＡ）治疗房室折返性心动过速（ＡＶＲＴ）和房室结折返性心动过速（ＡＶＮＲＴ）已十分成熟。房性心动过速（ＡＴ）在临床上较少见且药物难以控制,ＲＦＣＡ治疗房速的报道也较少［１］,其成功率在６０％～９０％。作者总结了４例房速的ＲＦＣＡ,...     

显性预激综合征与房室折返性心动过速100例分析

分析１００例显性预激综合征食管心房调搏的资料，结果表明：①诱发顺向型房室折返性心动过速（Ｏ－ＡＶＲＴ）４９例，左侧旁道（ＡＰ）较右侧ＡＰ发生率高；逆向型房室折返性心动过速（Ａ－ＡＶＲＴ）３例，均见于右侧ＡＰ。前向与逆向的单次折返１３例。房室折返性心律失常总计６５例，占６５％。②Ｏ－ＡＶＲＴ的形成应具备旁道前传的有效不应期（ＡＰＡ－ＥＲＰ）＞房室结有效不应期（ＡＶＮ－ＥＲＰ）＞左房有效不应期（ＬＡ－ＥＲＰ）。Ａ－ＡＶＲＴ的形成，应具备ＡＶＮ－ＥＲＰ＞ＡＰＡ－ＥＲＰ＞ＬＡ－ＥＲＰ。③房室折返性心动过速的诱发以Ｓ_１Ｓ_２及分级递增法为最佳。     

持续性交界区反复性心动过速的近年研究进展

持续性交界区反复性心动过速 (Ｐｅｒｍａｎｅｎｔｊｕｎｃ ｔｉｏｎａｌｒｅｃｉｐｒｏｃａｔｉｎｇｔａｃｈｙｃａｒｄｉａ,ＰＪＲＴ)是一种临床少见而药物治疗效果不佳的心律失常。 1967年 ,法国学者Ｃｏｕｍｅｌ率先报告了ＰＪＲＴ ,提出其临床特点和电生理的特征。 1978年Ｇａｌｌａｇｈｅｒ对ＰＪＲＴ作了进一步较为全面的阐述。 1984年意大利学者Ｃｒｉｔｅｌｌｉ指出ＰＪＲＴ好发于房室交界区 ,该旁道具有慢旁道特性[1] 。随着心脏电生理研究的不断深入 ,人们对ＰＪＲＴ的认识也更加清楚 ,现已证实ＰＪＲＴ实质为慢旁路参与的顺向型…     

房性心动过速的导管射频消融治疗

对４例房性心动过速（房速）患者进行心内电生理标测和导管射频消融治疗，探讨房速的电生理特点。其中男性２例、女性２例，年龄２４～５６岁，均有明确的房速发作史（１０个月～１０年），发作时心室率１５０～２２０ｂｐｍ，食管起搏均能诱发与终止房速。心动过速时食管...     

射频消融术成功治愈1例18个月持久性交界反复性心动过速

００６ 射频消融术成功治愈１例１８个月持久性交界反复性心动过速［ＢａｌａｊｉＳ等．ＡｍＨｅａｒｔＪ，１９９４，１２７（５）：１４２０（英文）］持久性交界反复性心动过速（ＰＪＲＴ）是一种罕见的难治性心律失常，虽然很少恶化，但可出现慢性心衰。本文报告１例...     

Tachycardia induced tachycardia: case report of right ventricular outflow tract tachycardia and AV nodal reentrant tachycardia

Tachycardia induced tachycardia, or so called double tachycardia, is rare. A 34 year old woman is described who had a history of syncope, frequent extrasystoles, and episodes of non-sustained ventricular tachycardia, perceived as palpitation, without syncope. At electrophysiological study, during infusion of isoprenaline, an episode of non-sustained ventricular tachycardia arising from the right ventricular outflow tract initiated sustained atrioventricular nodal reentrant tachycardia, thought to be the cause of the patient's syncope. Ablation of the right ventricular outflow tract focus abolished the ventricular ectopy; the slow AV nodal pathway was also ablated. The patient no longer has either syncope or palpitation.     

体表心电图对房室结折返性与房室折返性心动过速的鉴别诊断

为探讨体表心电图对房室结折返性和房室折返性心动过速的鉴别诊断价值,对以射频导管消融、心脏电生理检查、心外膜标测的方法确诊房室结折返性心动过速(AVNRT)和房室折返性心动过速(AVRT)的88例患者的室上性心动过速发作时心电图作对照研究。结果显示:(1)P'波出现率在AVNRT占33％,在AVRT占100％(P<0.01)。(2)R-P'间期<80ms时常见于AVNRT,而≥80ms多见于AVRT(P<0.01)。(3)AVNRT在下壁导联(Ⅱ、Ⅲ、aVF)常见假性S波,而V_1导联常合并假性r波。(4)AVRT无文氏现象,但常出现束支传导阻滞改变且符合Coumel-Slama定律。认为以上特点对两者鉴别诊断有重要价值。     

Griffith法Brugada法诊断宽QRS性室上性心动过速

为了解Griffith法和Brugada法诊断宽QRS性室上性心动过速（SVT）的价值，选择34例心电图表现为宽QRS心动过速者，其中SVT25例，室性心动过速（VT）9例，均经心脏电生理检查证实，采用上述两法进行了比较和综合分析。结果发现，Griffith法诊断SVT的敏感性、特异性和假阴性率分别为76％、77．8％和24％；而Brugada法的则分别为80％、88．9％和20％；两者合用时分别为84％、88．9％和16％。4例SVT为右侧旁路前传者均不符合诊断标准。认为，Griffith法和Brusada法或二者合用对SVT合并原有束支阻滞或室内差异性传导者有较高的诊断价值，而对预激旁路前传的SVT诊断价值低。     

Idiopathic verapamil-sensitive sustained left ventricular tachycardia

Idiopathic verapamil-sensitive left ventricular tachycardia (VT) has characteristic QRS configurations during VT: right bundle-branch block with either left axis or right axis (less common) deviation. QRS duration is relatively narrow (0.13-0.16s) and frequently endocardial activation prior to QRS is recorded during VT, which is the basis of its being called fascicular tachycardia. The mechanism is probably reentry, but the nature of the slow conduction necessary for the occurrence of reentry is quite different from that of other sustained monomorphic VT associated with structural heart disease. Chronic oral verapamil therapy is the drug of choice for alleviation of symptoms. Long-term prognosis is good.     

The differential diagnosis on the electrocardiogram between ventricular tachycardia and preexcited tachycardia

The 12-lead surface electrocardiogram is a simple and useful tool for the differential diagnosis of regular wide QRS complex tachycardia. However, criteria do not as yet exist to discriminate between ventricular tachycardia and supraventricular tachycardia with anterograde conduction over an accessory pathway (preexcited tachycardia). Therefore, we designed a new stepwise approach with three criteria for the electrocardiographic differential diagnosis between ventricular tachycardia and preexcited tachycardia and prospectively studied 267 regular tachycardias with electrophysiologically proven mechanism and a wide QRS complex (≥ 0.12 s): 149 consecutive ventricular tachycardias and 118 consecutive preexcited regular tachycardias. Underlying heart disease was old myocardial infarction in 133 of 149 (89%) ventricular tachycardias. The patients presenting with preexcited tachycardia had no additional structural heart disease. Atrial fibrillation with preexcited QRS complex was not included. The criteria favoring ventricular tachycardia were: (1) presence of predominantly negative QRS complexes in the precordial leads V₄ to V₆, (2) presence of a QR complex in one or more of the precordial leads V₂ to V₆, and (3) AV relation different from 1:1 (more QRS complexes than P waves). The final sensitivity and specificity of these three consecutive steps to diagnose ventricular tachycardia were 0.75 and 1.00, respectively. This new stepwise approach is sensitive and highly specific for the differential diagnosis between ventricular tachycardia in coronary artery disease and preexcited regular tachycardia.     

Incidence and clinical significance of inducible atrial tachycardia in patients with atrioventricular nodal reentrant tachycardia

INTRODUCTION: The purpose of this prospective study was to determine the prevalence and clinical significance of inducible atrial tachycardia in patients undergoing slow pathway ablation for AV nodal reentrant tachycardia who did not have clinically documented episodes of atrial tachycardia. METHODS AND RESULTS: Twenty-seven (15%) of 176 consecutive patients who underwent slow pathway ablation for AV nodal reentrant tachycardia were found to have inducible atrial tachycardia with a mean cycle length of 351+/-95 msec. The atrial tachycardia was sustained in 7 (26%) of 27 patients and was isoproterenol dependent in 20 patients (74%). The atrial tachycardia was not ablated or treated with medications, and the patients were followed for 9.7+/-5.8 months. Six (22%) of the 27 patients experienced recurrent palpitations during follow-up. In one patient each, the palpitations were found to be due to sustained atrial tachycardia, nonsustained atrial tachycardia, recurrence of AV nodal reentrant tachycardia, paroxysmal atrial fibrillation, sinus tachycardia, and frequent atrial premature depolarizations. Thus, only 2 (7%) of 27 patients with inducible atrial tachycardia later developed symptoms attributable to atrial tachycardia. CONCLUSION: Atrial tachycardia may be induced by atrial pacing in 15% of patients with AV nodal reentrant tachycardia. Because the vast majority of patients do not experience symptomatic atrial tachycardia during follow-up, treatment for atrial tachycardia should be deferred and limited to the occasional patient who later develops symptomatic atrial tachycardia.