不同机制室上性心动过速患者起病年龄及发作时心率的性别差异

目的 探讨不同机制室上性心动过速患者发病时年龄、发作时心率及其性别差异。方法 回顾性分析118例阵发性室上性心动过速患者临床资料，分析其发病时年龄及发作时心率的性别差异，并根据心内电生理检查结果分组。结果 心动过速发作时女性心率快于男性心率；房室结折返性心动过速患者发病年龄小于房室折返性心动过速患者，且房室折返性心动过速患者女性发病早于男性，其在隐匿旁路患者中差异有显著性；隐匿旁路患者室上性心动过速发作时心率快于显性旁路者。结论 不同机制、不同性别的室上性心动过速患者初次发作时年龄、发作时心率不同。     

房室结折返性心动过速与房室折返性心动过速临床对比分析

阵发性室上性心动过速(PSVT)是临床常见的心律失常。我院从1993年4月至1997年12月经射频消融治疗PSVT189例,经心内电生理检查证实为房室结折返性心动过逮(AVNRT）(慢一快型)47例,占24盯％;房室折返性心动过逮(AVRT)142例．占75.13％。本就经心内电生理检查明确的AVRT的临床表现、体表心电图等方面做一对比分析。     

第3讲 阵发性室上性心动过速的鉴别诊断

阵发性室上性心动过速（paroxysmal supraventricular tachycardia,PSVT）简称室上速,异位激动点在希氏束以上,心动过速形成时心室不是必须参与成分,大多数心电图表现为QRS波群形态正常、RR间期规则的快速心律。多数室上速由折返机制引起,折返可发生在窦房结、房室结、心房,分别称为窦房折返性心动过速、房室结内折返性心动过速（AVNRT）、心房折返性心动过速。     

新生儿预激综合征并室上性心动过速

预激综合征系由于心房、心室肌之间的联系，除了正常的房室结——希蒲氏系统之外，还有“异常附加旁道”。该征并发异位心动过速已成为历史。但本院近2个月出现几例新生儿预激综合征并室上性心动过速。特报道其中1例如下。     

心律平治疗阵发性室上性心动过速的疗效观察及护理

阵发性室上性心动过速简称室上速，包含窦房结、房室结、心房与心宦共同参与形成大折返回路的房室折返性心动过速这样一大类心动过速。我院急诊科应用心律平静脉注射治疗室上速，取得满意效果，现报告如下。     

房室结折返性与心房内折返性心动过速并存的食管电生理及临床分析

我院自1985年至2004年进行食管电生理检查,共查出房室结折返性心动过速者300例,其中房室结折返性心动过速合并心房内折返性心动过速者14例.现就此进行临床分析.     

射频消融治疗希氏束旁房性心动过速3例的护理

射频消融治疗房性心动过速（以下简称房速）是一种安全有效的方法,尤其对于药物治疗效果不佳的房速,在诱发、标测和消融方面都有各自的特殊性。Koch三角区域由于解剖结构的特殊性,是房速的好发部位,而Koch三角尖即在希氏束旁。我科于2002年4月至2004年5月利用射频消融术成功治疗3例希氏束旁房速的患者,现将护理体会报道如下：     

房室结折返性心动过速的基础与临床

广义的室上性心动过速(SVT)指的是异位起搏点或折返环在希氏束分叉以上的心动过速。人类SVT的分类见表1,SVT的机理见表2。房室结折返性心动过速(AVNRT)为SVT的常见类型,占SVT的23.5％～63.5％,本文就其解剖基础、发病机理、电生理特点及治疗作一简述。     

阵发性房室结折返性心动过速患者慢径路消融治疗的临床分析

目的探讨射频消融慢径路治疗阵发性房室结折返性心动过速（AVNRT）的临床效果。方法回顾性分析425例采用射频消融治疗的AVNRT患者的临床资料。结果417例手术成功，成功率98．12％。4例（0．94％）出现高度房宣传导阻滞，2例（0．47％）因心室率较慢而安装永久性起搏器。随访6个月内有8例复发，复发率1．9％。结论选择性慢径路消融是成功治愈AVNRT安全有效的方法。     

射频消融治疗房室结折返和房室折返性心动过速

目的：总结射频消融(RFCA)治疗房室结折返性心动过速和房窒折返性心动过速的经验。方法：分析67例阵发性室上性心律失常病人的RFCA过程；房室结折返性心动过速(AVNRT)49例，房室折返性心动过速(AVRT)18侧。结果：消融成功率98．5％，复发率1．5％，并发症发生率2．98％。结论：RFCA是治疗AVNRT和AVRT安全有效的方法。     

Paroxysmal supraventricular tachycardia in an octogenarian

Background

Paroxysmal supraventricular tachycardia is a common dysrhythmia that occurs at all ages. Its management is determined by presenting symptoms and previous history of the patient. Patients present with a continuum of symptoms ranging from palpitations to syncope. The incidence of supraventricular tachycardia increases with age.

Objectives

To discuss the etiology, precipitating factors, and acute management of supraventricular tachycardia; and to discuss nodal reentry circuits and representative electrocardiographic findings.

Case Report

We present the case of an 84-year-old man with gallstone pancreatitis, choledolcholithiasis, and cholecystitis complicated by paroxysmal supraventricular tachycardia. We review this dysrhythmia, emphasizing its significance in elderly patients.

Conclusion

Supraventricular tachycardia is a common dysrhythmia that can result in syncope or myocardial infarction. We present a case of an elderly man with new-onset atrioventricular (AV) nodal reentry tachycardia, possibly precipitated by overdrive of his autonomic nervous system due to pain and infection. As the percentage of the elderly in our population is growing rapidly and the incidence of AV nodal reentry tachycardia increases with age, emergency physicians should be familiar with this dysrhythmia—its etiology, precipitating factors, presentations, and treatment. It will present more frequently in the future.     

Self-conversion of supraventricular tachycardia by rapid atrial pacing.

The use of pacemakers in the treatment of tachycardias is one of the most exciting and rapidly expanding applications of cardiac pacing. One of the more recent developments in this field has been the use of patient-activated radio frequency transmitted rapid atrial stimulation (RAS) in the treatment of paroxysmal supraventricular tachycardia (PSVT). Based on the previously established ability of asynchronous atrial pacing to interrupt a variety of re-entrant supraventricular rhythm disturbances, this modality of treatment is gaining increasing applicability in patients with PSVT associated with debilitating symptoms or other severe cardiovascular consequences in whom standard pharmacological regimens have either failed or are impossible to maintain for indefinite periods. This report describes our experience with five patients who underwent implantation of RAS units. The detailed electrophysiological studies required to ensure success and avoid any possible future complications are described. Over a follow-up period of four months to four years (mean 16 months) very few problems arose in the use of these units which have immeasurably improved the quality of life of the recipients. Our experience with RAS units has led to a few suggestions for future improvement and these are outlined in this report. The excellent patient acceptance and the reliability of this technique in terminating episodes of PSVT should, in the future, render RAS the treatment of choice in certain selected patients suffering from this common disorder.     

室上性心动过速161例食管心房调搏资料分析

对161例SVT食管心房调搏资料的分析表明:1.预激综合征(包括隐匿性)是SVT最常见的原因,本组占50%(81/161);其次是房室结双径路,占43%(70/161)。2.食管心房调搏诱发SVT 112例(诱发率70%),其电生理机制以AVRT为第一位,占54%;AVNRT为第二位,占38%,证实国人SVT电生理机制情况与国外相比有不同的特点。3.用食管心房调搏可对SVT进行电生理分型,并作出无创性鉴别诊断。     

房室折返性心动过速伴RR间期长短交替发生机制的研究

目的探讨房室折返性心动过速(atrioventricular reciprocating tachycardia,AVRT)伴RR间期长短交替的发生机制。方法回顾性分析2009年8月至2016年8月,在泰达国际心血管病医院心内科经导管射频消融治疗的AVRT患者317例临床资料,AVRT时给予异博定5 mg,缓慢静脉推注10 min,给药后观察是否有RR间期、AH间期、HV间期和VA间期变化,以及变化发生的时间。结果给予异博定后有8例患者发生RR间期长短交替,并且均伴QRS波电交替,RR间期长短交替现象发生时均为相邻心搏的AH间期差值逐渐延长,无AH跳跃,HV间期和VA间期恒定,此现象发生于给药后6~17 min,心动过速平均周期比给药前延长16~42 ms;3例患者RR间期长短交替现象消失时均为相邻心搏的AH间期差值逐渐缩短,无AH跳跃,HV和VA间期恒定,直至AH间期相等,消失时间为给药后19~57 min;5例患者给药后AVRT终止。结论由此推断其发生机制是由于心动过速时AH间期频率依赖性递减传导所致,这一心电现象不能被程序刺激诱发。     

Electrophysiological markers predicting impeding AV‐block during ablation of atrioventricular nodal reentry tachycardia

1 Background

Radiofrequency (RF) ablation of the slow pathway (SP) in atrioventricular nodal reentry tachycardia (AVNRT) is occasionally complicated with atrioventricular block (AVB) often predicted by junctional beats (JB) with loss of ventriculo‐atrial (VA) conduction.

2 Methods

We analyzed retrospectively 153 patients undergoing ablation of SP for typical AVNRT. Patients were divided into two age groups: 127 ≤ 70 years and 26 > 70 years. We analyzed the interval between the atrial electrogram in the His‐bundle position and the distal ablation catheter [A(H)‐A(RFd)] and between the distal ablation catheter and the proximal coronary sinus catheter [A(RFd)‐A(CS)] before RF applications with and without JB. We evaluated if these intervals can be used as predictors of JB incidence and also of JB with loss of VA conduction. We also assessed if age influences the risk of loss of VA conduction.

3 Results

The A(H)‐A(RFd) and A(RFd)‐A(CS) intervals were significantly shorter in RF applications causing JB than those without JB (33 ± 11 ms vs 39 ± 9 ms, P < 0.001, 14 ± 9 ms vs 20 ± 7 ms, P < 0.001, respectively). The A(H)‐A(RFd) and A(RFd)‐A(CS) intervals were also significantly shorter in RFs causing JB with VA block than those with VA conduction (29 ± 11 ms vs 35 ± 11 ms, P < 0.001, 8 ± 8 ms vs 17 ± 8 ms, P < 0.001, respectively). Patients > 70 years had shorter intervals (36 ± 11 ms vs 29 ± 8 ms, P  =  0.012, 17 ± 8 ms vs 13 ± 7 ms, P  =  0.027, respectively), while VA block was more common in this age group.

4 Conclusions

The A(H)‐A(RFd) and A(RFd)‐A(CS) intervals can be used as markers for predicting JB occurrence as well as impending AVB. JB with loss of VA conduction occur more often in older patients possibly due to a higher position of SP.     

An unusual cause of ventricular tachycardia

Inflammatory pseudotumour (IP) of the heart is an extremely uncommon and potentially fatal lesion which presents a challenging diagnosis even for the experienced pathologist, cardiologist and cardiac surgeon. This spindle cell tumour is known to be present in virtually every anatomical region but, in adults, has only previously been found in the heart at postmortem. We report the case of a 27-year-old man who presented with ventricular tachyarrhythmias and a right ventricular mass which was subsequently shown to be an IP.     

Paroxysmal supraventricular tachycardia induced by oral stimulation: a case report and review of swallow-induced dysrhythmias

We present the case of a 54-year-old man who experienced reproducible paroxysmal supraventricular tachycardia (SVT) with simple oral stimulation. The tachycardia was felt to be focal atrial fibrillation, and the patient was placed on propafenone with good results. There are no previous known cases of this exact condition. However, this may represent a variant of swallow-induced tachycardia. Case reports involving swallow-induced tachycardia with speculated mechanisms and treatments are discussed.     

Radiofrequency ablation of probable atrioventricular nodal reentrant tachycardia in children with documented supraventricular tachycardia without inducible tachycardia

The reproducible induction of supraventricular tachycardia (SVT) during electrophysiological study is critical for the diagnosis of atrioventricular nodal reentry tachycardia (AVNRT), and for determining a therapeutic endpoint for catheter ablation. In the sedated state, there are patients with reentry SVT due to AVNRT who are not inducible at electrophysiological study. This article reports on the empiric slow pathway modification for AVNRT in six pediatric patients (age 6-17, mean 13.3 years) with documented, recurrent, paroxysmal SVT in the setting of a structurally normal heart who were not inducible at electrophysiological study. Atrial and ventricular burst and extrastimulus pacing at multiple drive cycle lengths were performed in the baseline state, during an isuprel infusion, and during isuprel elimination. Single AV nodal (AVN) echo beats were present in all patients, while classic dual AVN physiology was present in three of six patients. Radiofrequency energy was administered in the right posteroseptal AV groove resulting in accelerated junctional rhythm in five of six patients. Postablation testing demonstrated the elimination of echo beats in four patients, while dual AVN physiology and echo beats persisted in two patients. At follow-up (22-49 months, mean 29.5 months), all patients are asymptomatic without recurrence of SVT and are not taking any antiarrhythmic medication. In selected patients, empiric slow pathway modification may be offered as a potential cure in children with recurrent paroxysmal SVT who are not inducible at electrophysiological study. Elimination of slow pathway conduction may serve as a surrogate endpoint, though is not necessary for long-term success.