Esophageal stimulation was performed in 40 patients who had spontaneous paroxysmal supraventricular tachycardias (SVTs). The purpose of this study was to look for the most sensitive stimulation protocol and criteria that would help to define the mechanism of reentry. In 20 patients (group I) atrial pacing up to second-degree atrioventricular block was performed under control conditions and isoproterenol, and SVT was induced in 14 patients (70%), 11 in the control state and 3 while receiving isoproterenol. In 20 patients (group II) atrial pacing and programmed atrial stimulation using 1 and 2 extrastimuli delivered at 2 cycle lengths (600 and 500 ms) was performed in the control state and while receiving isoproterenol. SVT was induced in all patients, in 13 patients in the control state and in 7 while receiving isoproterenol. Programmed stimulation always induced SVT and was the only method capable of tachycardia induction in 14 patients. The mechanism of SVT could be established in 91%. The measurement of the ventriculoatrial interval was the most useful sign to define the site of reentry. Occurrence of a bundle branch block helped to delineate the mechanism in 4 patients. When a positive P wave in V1 preceded the esophageal atrial electrocardiogram, it suggested that there was reentry through a left-sided accessory atrioventricular connection in 6 patients. SVT could always be induced by programmed atrial stimulation in the control state and under isoproterenol. The location of the P wave in V1 compared to the ventriculogram and the esophageal electrocardiogram helped to define the mechanism of tachycardia.

译文

对40例自发性阵发性室上性心动过速 (SVTs) 的患者进行了食管刺激。这项研究的目的是寻找最敏感的刺激方案和标准,以帮助定义折返的机制。在20例患者 (I组) 中,在控制条件和异丙肾上腺素下进行心房起搏至二度房室传导阻滞,并在14例患者 (70% 例) 中诱导SVT,在控制状态下11例,在接受异丙肾上腺素的同时诱导3例。在20例患者 (II组) 中,在对照状态下并接受异丙肾上腺素时,使用以2个周期长度 (600和500 ms) 递送的1个和2个外刺激进行心房起搏和程序化心房刺激。在接受异丙肾上腺素的所有患者中,在控制状态下的13例患者和在接受异丙肾上腺素的7例患者中诱导了SVT。程序性刺激总是引起SVT,并且是14例患者中唯一能够诱导心动过速的方法。SVT的机制可以在91% 中建立。测量心室间隔是定义折返部位的最有用标志。束支阻滞的发生有助于描述4例患者的机制。当在食管心房心电图之前出现V1阳性P波时,提示6例患者通过左侧副房室连接折返。在控制状态和异丙肾上腺素下,总是可以通过程序性心房刺激诱导SVT。与心室图和食管心电图相比,V1中P波的位置有助于确定心动过速的机制。

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