第61课 心房颤动时不寻常心动过速一心动过缓综合征，何为机制？.pdfVIP

lation．Ithasbeendemonstratedthatpacingproximalto taneousprematureventricularcomplexoriginatingrfom theHisbundlelesion(atrialordirectHisbundlepacing) theleftanteriorseptum wasabletoinducetransientin—— may nottriggerfatigue phenomenon，whereasdirect frahisianblock(Fiugre3A)．Incontrast，spontaneous(or pacingoftheleftbundlebranchjustdistallytothele— mechanicallyinduced)prematureventricularcomplexes sion does． The underlying mechanisms of these originatingfrom therightventricularapexwerenotas—— anisotropicspecificpropertiesofdiseaseHPS remain sociatedwithsubsequentAV block，despiteanidentical unclear，butinourcaseonemayalsosupposethatrela— couplinginterval (Fiugre3B)．Theexplanationmaybe tivelyslow conductionthroughtheAV nodemayhave basedon theunderstanding ofthepatternsofnormal initiallyprotectedthediseasedHPSrfom overdrivesup。- andabnomralretrorgadeHis—Purkinjeconduction．Ir— pression．ThepersistentAFdidnotallow HStoassess respectiveofthesiteoforigin，itiswelldescribedthat furthermoreanterogradepropertiesofAV conductionin the preferred retrorgade conduction pathway is the thispatient． left—-sidedHPSbecauseofshorterretrorgadererfactory period within the left bundle branch system．These M echanism 2：PeelingBack propertiesexplainwhyleftbundle——branchblockpattern Thismechanism hasbeenalternatelydescribedas predominatesinbundlebranch re—entry VT，which is apeelingbackofthererfactorybarrier，wherebyanin— rfequentlyobservedinpatientswithleftbundle—-branch creasedtachycardiarate ordegreeofprematurity)re— block and aprolonged hisioventricularinterva1．This suitsinprorgessivelydeeperretrorgadepenetrationof mightalsoexplainwhyfatiugephenomenon israrely theimpulsesintoareasofdamagedHisbundlefibers． observed．Duringelectrophysi01ogieals