第95课 窄QRS波群心动过速伴房室分离:机制是什么?  

Lesson Ninety-five A narrow complex tachycardia with atrioventricular dissociation:What is the mechanism?

作　　者：童鸿 

机构地区：[1]不详

出　　处：《心电与循环》2020年第3期315-318,共4页Journal of Electrocardiology and Circulation

摘　　要：1例74岁女性因反复症状性心动过速行诊断性电生理检查。基础状态下心房-希氏束间期和希氏束-心室间期分别为75ms和50ms。程序心房期外刺激诱发出房室结双径路,而滴注异丙肾上腺素下心室起搏未见室房传导。图1是她临床发作时的心动过速。图2上图显示心动过速对希氏束不应期间心室期前除极(VPD)的反应,图2中图和下图显示快速心室起搏(340ms)二次诱发。基于这些,心动过速的机制是什么?Case Presentation A 74-year-old woman underwent diagnostic electrophysiologic study because of recurrent,symptomatic supraventricular tachycardia.Baseline atrio-His1 and His-ventricular intervals measured 75 ms and 50ms,respectively.Programmed atrial extrastimu-lation elicited dual atrioventricular(AV)nodal physiology and ventricular pacing showed no ventriculoatrial conduction despite isoproterenol.Figure 1 shows her clinical tachycardia.The response of tachycardia to a His-refractory ventricular premature depolarization(VPD)is shown in the top section of Figure 2,while its induction twice by rapid ventricular pacing(340 ms)is shown in the middle and bottom sections of Figure 2.Based on these observations,what is the mechanism of tachycardia?

关 键 词：心动过速 希氏束 电生理检查 房室分离 临床发作 房室结双径 快速心室起搏 症状性 

分 类 号：R541.7[医药卫生—心血管疾病]