BACKGROUND Most Mahaim fibers are right free-wall atriofascicular accessory pathways with only antegrade conduction.Concealed Mahaim fiber is not very rare;however,concealed nodoventricular fiber is a very rare kind o...BACKGROUND Most Mahaim fibers are right free-wall atriofascicular accessory pathways with only antegrade conduction.Concealed Mahaim fiber is not very rare;however,concealed nodoventricular fiber is a very rare kind of retrograde accessory pathway in supraventricular tachycardia with atrioventricular(AV)dissociation.Only a few cases about successful ablation of the nodoventricular accessory pathway have been reported.We describe the case of a 32-year-old woman who underwent an electrophysiology study and radiofrequency(RF)ablation of a rare narrow QRS tachycardia with AV dissociation.CASE SUMMARY A 32-year-old woman with a history of paroxysmal palpitation was admitted to our hospital for RF ablation.Electrocardiography revealed a narrow QRS complex tachycardia with the same morphology in sinus rhythm.Echocardiography showed no structural heart disease.A right-sided concealed AV accessory pathway and a right-sided concealed nodoventricular accessory pathway were involved in the orthodromic atrioventricular reciprocating tachycardia.His bundle-ventricular interval during tachycardia was the same as that in sinus rhythm.The tachycardia could be initiated and entrained by ventricular pacing.Premature right ventricular stimulus introduced during the His-bundle refractory period when tachycardia occurred was able to advance the next atrial potential.The earliest atrial activation was mapped near the proximal slow AV nodal pathway.RF ablation of both accessary pathways was successfully performed under the guidance of a three-dimensional mapping system by recording the earliest retrograde atrial potential,and tachycardia could no longer be induced.CONCLUSION Narrow QRS tachycardia with AV dissociation is inducible by concealed nodoventricular fiber and ablated by recording the earliest retrograde atrial potential.展开更多
永存左上腔静脉(persistent left superior vena cava,PLSVC)是由左前主干静脉退化失败所致,是上腔静脉最常见的畸形,也是最常见的先天性胸腔静脉异常,总患病率为0.35%~0.5%[1-3]。PLSVC伴右上腔静脉缺如(absent right superior vena ca...永存左上腔静脉(persistent left superior vena cava,PLSVC)是由左前主干静脉退化失败所致,是上腔静脉最常见的畸形,也是最常见的先天性胸腔静脉异常,总患病率为0.35%~0.5%[1-3]。PLSVC伴右上腔静脉缺如(absent right superior vena cava,ARSVC)是一种非常罕见的静脉畸形,称为孤立性PLSVC,发生率为0.09%~0.13%[3]。本文报道1例罕见的儿童孤立性PLSVC,早期诊断为窄QRS波心动过速,经心脏电生理检查明确诊断为房室结功能异常,完全性房室分离伴交界性自主节律、室性心动过速。展开更多
文摘BACKGROUND Most Mahaim fibers are right free-wall atriofascicular accessory pathways with only antegrade conduction.Concealed Mahaim fiber is not very rare;however,concealed nodoventricular fiber is a very rare kind of retrograde accessory pathway in supraventricular tachycardia with atrioventricular(AV)dissociation.Only a few cases about successful ablation of the nodoventricular accessory pathway have been reported.We describe the case of a 32-year-old woman who underwent an electrophysiology study and radiofrequency(RF)ablation of a rare narrow QRS tachycardia with AV dissociation.CASE SUMMARY A 32-year-old woman with a history of paroxysmal palpitation was admitted to our hospital for RF ablation.Electrocardiography revealed a narrow QRS complex tachycardia with the same morphology in sinus rhythm.Echocardiography showed no structural heart disease.A right-sided concealed AV accessory pathway and a right-sided concealed nodoventricular accessory pathway were involved in the orthodromic atrioventricular reciprocating tachycardia.His bundle-ventricular interval during tachycardia was the same as that in sinus rhythm.The tachycardia could be initiated and entrained by ventricular pacing.Premature right ventricular stimulus introduced during the His-bundle refractory period when tachycardia occurred was able to advance the next atrial potential.The earliest atrial activation was mapped near the proximal slow AV nodal pathway.RF ablation of both accessary pathways was successfully performed under the guidance of a three-dimensional mapping system by recording the earliest retrograde atrial potential,and tachycardia could no longer be induced.CONCLUSION Narrow QRS tachycardia with AV dissociation is inducible by concealed nodoventricular fiber and ablated by recording the earliest retrograde atrial potential.
文摘永存左上腔静脉(persistent left superior vena cava,PLSVC)是由左前主干静脉退化失败所致,是上腔静脉最常见的畸形,也是最常见的先天性胸腔静脉异常,总患病率为0.35%~0.5%[1-3]。PLSVC伴右上腔静脉缺如(absent right superior vena cava,ARSVC)是一种非常罕见的静脉畸形,称为孤立性PLSVC,发生率为0.09%~0.13%[3]。本文报道1例罕见的儿童孤立性PLSVC,早期诊断为窄QRS波心动过速,经心脏电生理检查明确诊断为房室结功能异常,完全性房室分离伴交界性自主节律、室性心动过速。
