Autonomically-induced change in the direction of reentrant circuit in a patient with dual A-V nodal pathways
二重房室結節伝導路を基盤として発生する房室結節リエントリー性頻拍(AVNRT)には遅伝導路を順伝導し速伝導路を逆伝導する遅速型と逆の興奮回旋を示す速遅型が知られているが,後者はまれである.我々は同一症例で両者の頻拍を認め,それらへの迷走神経遮断の影響を検討したので報告する.症例は70歳女性.14年前から時々,20分間前後の動悸発作を自覚していた.Holter心電図では心拍数増加時に30秒間前後のlong RP' tachycardiaを認めた.電気生理学的検査では,コントロールの右房早期刺激( S 1 S 2 S 3 法) によりA 3 H 3 およびH 2H3間隔のjump upを...
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| Published in | Shinzo Vol. 25; no. 6; pp. 691 - 695 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japan Heart Foundation
15.06.1993
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0586-4488 2186-3016 |
| DOI | 10.11281/shinzo1969.25.6_691 |
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| Abstract | 二重房室結節伝導路を基盤として発生する房室結節リエントリー性頻拍(AVNRT)には遅伝導路を順伝導し速伝導路を逆伝導する遅速型と逆の興奮回旋を示す速遅型が知られているが,後者はまれである.我々は同一症例で両者の頻拍を認め,それらへの迷走神経遮断の影響を検討したので報告する.症例は70歳女性.14年前から時々,20分間前後の動悸発作を自覚していた.Holter心電図では心拍数増加時に30秒間前後のlong RP' tachycardiaを認めた.電気生理学的検査では,コントロールの右房早期刺激( S 1 S 2 S 3 法) によりA 3 H 3 およびH 2H3間隔のjump upを生じ,遅速型(AH間隔340,HA間隔50msec)の持続性AVNRTが誘発された.Atropine静注後には速伝導路の不応期が選択的に短縮し,S1S2法により速遅型(AH間隔90,HA間隔240msec)と思われる非持続性AVNRT(long RP' tachycardia)が誘発された.以上自律神経トーヌス変化により異なる興奮旋回を示すAVNRTのまれな1例を報告した. |
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| AbstractList | 二重房室結節伝導路を基盤として発生する房室結節リエントリー性頻拍(AVNRT)には遅伝導路を順伝導し速伝導路を逆伝導する遅速型と逆の興奮回旋を示す速遅型が知られているが,後者はまれである.我々は同一症例で両者の頻拍を認め,それらへの迷走神経遮断の影響を検討したので報告する.症例は70歳女性.14年前から時々,20分間前後の動悸発作を自覚していた.Holter心電図では心拍数増加時に30秒間前後のlong RP' tachycardiaを認めた.電気生理学的検査では,コントロールの右房早期刺激( S 1 S 2 S 3 法) によりA 3 H 3 およびH 2H3間隔のjump upを生じ,遅速型(AH間隔340,HA間隔50msec)の持続性AVNRTが誘発された.Atropine静注後には速伝導路の不応期が選択的に短縮し,S1S2法により速遅型(AH間隔90,HA間隔240msec)と思われる非持続性AVNRT(long RP' tachycardia)が誘発された.以上自律神経トーヌス変化により異なる興奮旋回を示すAVNRTのまれな1例を報告した. |
| Author | Noma, Shigetaka Shinmura, Ken Nakamura, Yoshiro Inoue, Nagamu Miyazaki, Toshihisa |
| Author_FL | 宮崎 利久 新村 健 井上 詠 野間 重孝 中村 芳郎 |
| Author_FL_xml | – sequence: 1 fullname: 新村 健 – sequence: 2 fullname: 宮崎 利久 – sequence: 3 fullname: 井上 詠 – sequence: 4 fullname: 野間 重孝 – sequence: 5 fullname: 中村 芳郎 |
| Author_xml | – sequence: 1 fullname: Miyazaki, Toshihisa organization: Department of Cardiology, Saitama National Hospital – sequence: 1 fullname: Shinmura, Ken organization: Department of Geriatrics, Keio University School of Medicine – sequence: 1 fullname: Nakamura, Yoshiro organization: Department of Geriatrics, Keio University School of Medicine – sequence: 1 fullname: Inoue, Nagamu organization: Department of Cardiology, Saitama National Hospital – sequence: 1 fullname: Noma, Shigetaka organization: Department of Cardiology, Saitama National Hospital |
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| DocumentTitle_FL | 症例 自律神経トーヌス変化により異なる興奮旋回を示した房室結節リエントリー性頻拍症の1例 |
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| References | 2) Gallaghter JJ, Sealy WC: The permanent form of junctional reciprocating tachycardia: further elucidation of the underlying mechanis m. Eur J Cardiol 8: 413-430, 1978 3) Klein GJ, Prystowsky EN, Pritchett EL, et al: Atypical pattern of retrograde conduction over accessory atrioventricular pathways in the Wollf-Parkinson-White syndrome. Circulation 60: 1477-1486, 1979 8) Ross DL, Uther JB: Diagnosis of concealed, accessory pathways in supraventricu l a r tachycardia. PACE 7: 1069-1085, 1 984 4) Farre J, Fracp DR, Wiener I, et al: Reciprocal tachycardia using accessory pathw ays with long conduction times. Am J Cardiol 44: 1 099-1109, 1979 1) Guarnier T, German LD and Gallagher JJ: The long RP' tachycardia. PACE 10: 103-117, 1987 10) Brownstein SL, Hopson RC, Martins JB, et al: Usefullness of isoproterenol in facilitating atrioventricular nodal reentry tachy c ardia during electrophysiological testing. Am J Cardiol 61: 1037-1041, 1988 6)沖重薫, 鈴木文男, 田中一司, ほか: 稀有型房室結節リエントリー性頻拍の一例: slowKent 束の関与する房室リエントリー性頻拍との鑑別. Jpn J Electrocardiol 8: 819-826, 1988 9) Wu D, Denes P, Bauerfeind R, et al: Effects of atropine on induction and maintenance o f atrioventricular nodal reentrant tachycardi a, Circulation 59: 779-788, 1979 5) Guarnieri T, Sealy WC, Kasen JH, et al: The nonpharmacologic management of the per m anet form of juncional reciprocating tac h ycardia. Circulation 69: 269-277, 1984 11) Wu D, Denes P, Dhingra RC, et al: The effects of propranolol on induction of A-V n odal reentrant paroxysmal tachycardia. Circulation 50: 665-677, 1974 12)宮崎利久, 野間重孝, 細田泰雄, ほか: 房室結節リエントリー発生への自律神経修飾. 医療45: 744-750, 1991 7) Okumara K, Henthorn RW, Epstein AE, et al: Incessant atrioventricular reciprocating tachycardia utilizing left lateral AV bypass pathways with a long retrograde condution t ime. PACE 9: 332-342, 1986 |
| References_xml | – reference: 10) Brownstein SL, Hopson RC, Martins JB, et al: Usefullness of isoproterenol in facilitating atrioventricular nodal reentry tachy c ardia during electrophysiological testing. Am J Cardiol 61: 1037-1041, 1988 – reference: 12)宮崎利久, 野間重孝, 細田泰雄, ほか: 房室結節リエントリー発生への自律神経修飾. 医療45: 744-750, 1991 – reference: 1) Guarnier T, German LD and Gallagher JJ: The long RP' tachycardia. PACE 10: 103-117, 1987 – reference: 11) Wu D, Denes P, Dhingra RC, et al: The effects of propranolol on induction of A-V n odal reentrant paroxysmal tachycardia. Circulation 50: 665-677, 1974 – reference: 8) Ross DL, Uther JB: Diagnosis of concealed, accessory pathways in supraventricu l a r tachycardia. PACE 7: 1069-1085, 1 984 – reference: 2) Gallaghter JJ, Sealy WC: The permanent form of junctional reciprocating tachycardia: further elucidation of the underlying mechanis m. Eur J Cardiol 8: 413-430, 1978 – reference: 7) Okumara K, Henthorn RW, Epstein AE, et al: Incessant atrioventricular reciprocating tachycardia utilizing left lateral AV bypass pathways with a long retrograde condution t ime. PACE 9: 332-342, 1986 – reference: 9) Wu D, Denes P, Bauerfeind R, et al: Effects of atropine on induction and maintenance o f atrioventricular nodal reentrant tachycardi a, Circulation 59: 779-788, 1979 – reference: 4) Farre J, Fracp DR, Wiener I, et al: Reciprocal tachycardia using accessory pathw ays with long conduction times. Am J Cardiol 44: 1 099-1109, 1979 – reference: 6)沖重薫, 鈴木文男, 田中一司, ほか: 稀有型房室結節リエントリー性頻拍の一例: slowKent 束の関与する房室リエントリー性頻拍との鑑別. Jpn J Electrocardiol 8: 819-826, 1988 – reference: 5) Guarnieri T, Sealy WC, Kasen JH, et al: The nonpharmacologic management of the per m anet form of juncional reciprocating tac h ycardia. Circulation 69: 269-277, 1984 – reference: 3) Klein GJ, Prystowsky EN, Pritchett EL, et al: Atypical pattern of retrograde conduction over accessory atrioventricular pathways in the Wollf-Parkinson-White syndrome. Circulation 60: 1477-1486, 1979 |
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| Snippet | 二重房室結節伝導路を基盤として発生する房室結節リエントリー性頻拍(AVNRT)には遅伝導路を順伝導し速伝導路を逆伝導する遅速型と逆の興奮回旋を示す速遅型が... |
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| SubjectTerms | long RP' tachycardia 二重房室結節伝導路 自律神経トーヌス 速遅型房室結節リエントリー性頻拍 電気生理学的検査 |
| Title | Autonomically-induced change in the direction of reentrant circuit in a patient with dual A-V nodal pathways |
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