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Kokyu to Junkan Volume 36, Issue 11 （November 1988）

呼吸と循環 36巻11号（1988年11月発行）

Japanese English

症例

左側潜在性副伝導路と房室結節二重経路により3種類の回帰性頻拍を示した1例 A case with three different reciprocal tachycardias due to left concealed accessory pathway and dual A-V nodal pathways 坂東重信 ¹ , 横井良明 ² , 西角彰良 ¹ , 山本浩史 ¹ , 秋山恭介 ¹ , 森博愛 ¹ Shigenobu Bando ¹ , Yoshiaki Yokoi ² , Akiyoshi Nishikado ¹ , Hirofumi Yamamoto ¹ , Kyousuke Akiyama ¹ , Hiroyoshi Mori ¹ ¹徳島大学医学部第2内科 ²岸和田徳洲会病院循環器科 ¹The Second Department of Intenal Medicine, School of Medicine, The University of Tokushima ²The Division of Cardiology, Kishiwada Tokushukai Hospital pp.1241-1246

発行日 1988年11月15日 Published Date 1988/11/15

DOI https://doi.org/10.11477/mf.1404205367

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Abstract 文献概要
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　潜在性Wolff-Parkinson-White （WPW）症候群に伴う発作性上室性頻拍（paroxysmal supraventriculartachycardia, PSVT）は，房室結節を順行し，副伝導路を逆行する旋回路を形成する^1）。一方，房室結節二重経路（dual A-V nodal pathways, DAVNP）は房室結節回帰性頻拍の原因としてよく知られており，臨床的にみられる頻拍としては，slow pathwayを順行し，fast path-wayを逆行するslow-fast型頻拍が多い^2）。潜在性副伝導路とDAVNPの合併例においては，いくつかの旋回路が考えられ，数種の回帰性頻拍が出現する可能性がある。

　今回，著者らは房室結節二重経路を合併した潜在性WPW症候群の1例において，3種類の回帰性頻拍を経験したので報告する。

A case with three different reciprocal tachycardias due to left concealed accessory pathway and dual A-V nodal pathways was reported. The patient was 19-year-old women with a history of palpitation resulting from PSVT and her electrocardiogram showed no evidence of ventricular pre-excitation.

Electrophysiological studies revealed three dif-ferent reciprocal tachycardias. The first PSVT (PSVT 1) was induced by atrial extrastimulus at an A₁-A₂ of 250 msec during an atrial driven cycle length of 450 msec. This PSVT was characterized by early retrograde activation of left atrium, cycle length of 280 msec and Ae-H interval of 130 msec. This suggested the existence of a left accessory pathway. The second PSVT (PSVT 2) was induced by atrial pacing at the cycle length of 310 msec. This PSVT was initiated with a sudden remarkable prolongation of Ae-H interval and characterized by cycle length of 390 msec and Ae-H interval of 250 msec. This sudden increase of Ae-H interval revealed the existence of dual A-V nodal pathways. Retrograde atrial activation sequences during PSVT 2 was identical PSVT 1. The third PSVT (PSVT 3) was induced by rapid ventricular pacing at the cycle length of 280 msec. This PSVT was character-ized by normal retrograde atrial activation se-quences, atrial activation simultaneous with ventri-cular activation, cycle length of 310 msec and Ae-H interval of 265 msec. These findings were charac-teristics of slow-fast form of A-V nodal reentrant tachycardia. The fast pathway was used for ante-grade conduction in PSVT 1 and slow pathway in PSVT 2.

These observations suggested that a patient with concealed accessory pathway and dual A-V nodal pahways could be showed several forms of reciprocal tachycardia in some conditions.