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例1 男性,23岁,1990年4月21日因反复发作心动过速3年余,再次发作2小时急诊入院。查体无特殊发现。体表心电图示心动过速,室率为118 bpm,R-R间期平均510ms,心电轴—85°,QRS呈RBBB+LAD,QRS时限0.14s。从V_1导联清楚可见P在QRS波之后,似与QRS关系固定。而食管心电图上可见房室分离,房率略小于室率,P-P间期平均530ms,故确诊为VT(图1)。心房起搏(S_1S_1370ms)可以夺获心房及心室,但刺激停止后心动过速仍持续,且调搏时最后一个R_1至VT时第一个QRS波间距(相当于回复间期)等于VT时的R-R间期(图2);心室起搏(S_1S_1420ms)可夺获心室,但仍未能终止心动过速,回复间期亦等于或略长于VT时的基础周期(图3)。静注异搏定5mg后P-P间期由平均520ms延长至640ms,R-R间期由平均510ms延长610ms,其间可见室性节律与窦性夺获交替出现的“手风琴”现象。第一次给药后7分钟,再给异搏定5mg静脉注射时,恢复窦性心律。
Example 1 Male, 23 years old, April 21, 1990 due to recurrent tachycardia more than 3 years, another attack two hours emergency admission. Physical examination found no special. Surface ECG showed tachycardia with a ventricular rate of 118 bpm, an R-R interval of 510 ms, an ECG axis of -85 °, QRS RBBB + LAD, and QRS duration 0.14 s. Clearly seen from the V_1 lead P after QRS wave, and QRS relationship seems to be fixed. The esophageal electrocardiogram visible atrioventricular separation, slightly less room rate rate, P-P interval average 530ms, it is diagnosed as VT (Figure 1). Atrial Pacing (S_1S_1370ms) Atrial and ventricular seizures were achieved, but the tachycardia persisted after the stimulation was stopped and the first QRS wave interval (equivalent to the recovery interval) at the last R_1 to VT at pacing was equal to VT RR interval (Figure 2); ventricular pacing (S_1S_1420ms) can seize the ventricles, but still failed to terminate the tachycardia, the recovery interval is also equal to or slightly longer than the base period of VT (Figure 3). After the intravenous injection of verapamil 5mg P-P interval from an average of 520ms extended to 640ms, R-R interval 510ms extension of 610ms average, during which we can see the alternating rhythm of ventricular rhythm and sinus “Accordion” phenomenon. Seven minutes after the first dose, verapamil 5mg given intravenous injection, the restoration of sinus rhythm.