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本文报道一例非常独特的复发性宽QRS心动过速,窦性心律时PR间期及QRS形态正常,快速心房起搏时出现左束支阻滞伴电轴左偏的预激图形。电生理检查证实其副束具有前向传导延缓及渐减性传导的特性,其心动过速符合房室结折返性心动过速特点。诱发性心动过速的第1个QRS形态正常,其后则为与快速心房起搏形态相同的宽QRS。在心动过速中心室期前刺激能夺获心室及心房而不造成心动过速的中断或节律重整。此例心动过速的机理最可能是房室结内折返伴有前向传导延缓的旁观者房室副束,并讨论了与结室副束所致折返性心动过速的鉴别诊断问题。就作者所知,本例是文献上具有此种独特机理的心律失常的首例报告。
This article reports a very unique recurrent wide QRS tachycardia, sinus rhythm PR interval and QRS morphology is normal, rapid atrial pacing occurs left bundle branch block axis with left-axis pre-excitation graphics. Electrophysiological examination confirmed its accessory bundle has the characteristics of delayed conduction and decreasing conduction, and its tachycardia is consistent with the characteristics of atrioventricular nodal reentrant tachycardia. The first QRS pattern of induced tachycardia was normal followed by the same wide QRS as the rapid atrial pacing pattern. In the tachycardia before the ventricular stimulation can seize the ventricle and atrium without causing tachycardia interrupt or rhythm reorganization. The mechanism of tachycardia in this case is most likely to be the atrioventricular an accessory bundle of bystanders with anterior conduction delay and the differential diagnosis of reentrant tachycardia caused by the accessory bundle of the junctional compartment. To the best of the author’s knowledge, this is the first report of arrhythmia with this unique mechanism in the literature.