房室结折返性心动过速时房室非同步兴奋的电生理机制
MECHANISM OF UNSYNCHRONIZED ATRIOVENTR1CULAR ACTIVATION DURING ATRIOVENTR1CULAR NODAL REENTRANT TACHYCARDIA
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摘要: 13倒房室结折返性心动过速（AVNRT），其心动过速时表现为房室非同步兴奋，其中房室2：1传导11例，房室分离2例。房室非同步现象说明心房和心室并非AVNRT折返环路的必须部分。心房参与心动过速取决于结周心房组织的不应期，心室参与心动过速取决于希浦系统的不应期，由于心房组织的不应期通常较短，而希浦系统的不应用相对较长，因此非同步现象以房室阻滞或分离多见，室房阻滞或分离少见。正确识别AVNRT时房室非同步兴奋现象对于AVNRT的正确诊断及导管消融治疗有非常重要的意义。Abstract: Unsynchronized atrioventricualr activation during atrioventricular nodal reentranttachycardia (AVNRT) were seen in 13 patients, 11 of which had 2: 1 AV conduction, 2 AV dissocua-tion. This phenomenon illustrates that the atrium and the ventricle were not the necessary part of the reen-trant circuit. Whether the atrium can be 1: 1 involved in tachycardia depends on the effective refractoryperied (ERP) of Perinodal atrial tissue and the ventrivular depends on that of His - purkinje system. AVblock AV dissociation is common and VA block or VA dissociation uncommon because of longer ERP of His- Purkinje system and shorter ERP of atrial tissue. The recognization of the unsynchronized atrioventricu-lar activation phenonmenon during AVNRT is very important in diagnosing and radiofrequency catheter ab-lation of AVNRT.
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