Atrial Components Contributing to Pseudo r' Deflection in Lead V_1 in Slow/Fast Atrioventricular Nodal Reentrant Tachycardia : Analysis of the Atrial Activation Sequence by Basket Catheter Isochronal Mapping

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概要

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• Electrocardiographic recognition of the P' wave during tachycardia is very useful in the diagnosis of supraventricular tachycardias. In slow/fast (S/F) atrioventricular nodal reentrant tachycardia (AVNRT), no discrete P' waves are observed on ECG and pseudo r' deflection in lead V_1 (pseudo r') is commonly recognized. However, the atrial components that contribute to the genesis of pseudo r' in lead V_1 have not been described and this study aimed to clarify them by analysis of the whole activation sequence of the right atrium using Basket catheter isochronal mapping. The study group comprised 48 patients with AVNRT. Pseudo r' was defined as an upward deflection in the terminal portion of the QRS complex during tachycardia that was not recognized during sinus rhythm and it occurred in 45 patients (94%). During S/F AVNRT, the retrograde atrial activation was earliest on His bundle electrogram, followed by the coronary sinus ostium, distal coronary sinus and high right atrium. Only the high lateral aspect of the right atrium was activated after the end of the QRS complex. The interval between the onset of QRS in multiple surface ECG leads and the atrial activities on high right atrium was similar to the V-r' interval in lead V_1 (111±20ms, 117±11ms) and correlated with the V-r' interval (r=0.56). Pseudo r' deflection in lead V_1 is a highly sensitive indicator of S/F AVNRT, and appears to result from the activation of the superolateral aspect of the right atrium.

• 社団法人日本循環器学会の論文
• 2002-02-20

著者

• Suzuki Akihiro

  Department Of Cardiology Musashino Red Cross Hospital

• Yamaguchi Iwao

  Departments of Internal Medicine, Surgery, Pharmacology, University of Tsukuba

• Kanemoto Miyako

  Cardiology Department of Internal Medicine, University of Tsukuba Graduate School

• Kanemoto Miyako

  Department of Cardiology, Tsukuba Medical Center Hospital

• Endo Masae

  Department Of Cardiology Moriya General Daiichi Hospital

• Komaki Kohtaroh

  Division Of Cardiology Gunma Prefectural Cardiovascular Center

• Kuga Keisuke

  Department Of Cardiology

• Kanemoto Miyako

  Division Of Cardiology Tsukuba University Hospital Graduate School Of Comprehensive Human Sciences

• Kanemoto Miyako

  Division Of Cardiology Cardiovascular Center Tsuchiura Kyodo Hospital

• Endoh Masae

  Department Of Cardiology Moriya General Daiichi Hospital

• Kuga Keisuke

  Cardiology Department Of Internal Medicine University Of Tsukuba Graduate School Of Comprehensive Hu

• Li Aiyan

  Department of Internal Medicine, Institute of Clinical Medicine, University of Tsukuba

• Niho Bumpei

  Department of Internal Medicine, Institute of Clinical Medicine, University of Tsukuba

• Enomoto Mami

  Department of Internal Medicine, Institute of Clinical Medicine, University of Tsukuba

• Kajinami Koji

  Department of Cardiology Kanazawa Medical University

• Niho Bunpei

  Department Of Internal Medicine University Of Tsukuba

• Yamaguchi Iwao

  Division Of Cardiology Institute Of Clinical Medicine Graduate School Of Comprehensive Human Science

• Kanemoto Miyako

  Department Of Cardiology Tsukuba Medical Center Hospital

• Li Aiyan

  Department Of Internal Medicine Institute Of Clinical Medicine University Of Tsukuba

• Niho Bumpei

  Department Of Cardiology Tsukuba Memorial Hospital

• Enomoto Mami

  Department Of Internal Medicine University Of Tsukuba

• Yamaguchi Iwao

  Department Of Cardiology

• Niho Bumpei

  Department Of Internal Medicine University Of Tsukuba

• Kuga Keisuke

  Department Of Internal Medicine University Of Tsukuba

• Endo Masae

  Department Of Internal Medicine Moriya General Daiichi Hospital

• Suzuki Akihiro

  Department Of Anesthesiology And Critical Care Medicine Asahikawa Medical College

• Kanemoto Miyako

  Division Of Cardiology University Of Tsukuba Graduate School Of Comprehensive Human Sciences

• Yamaguchi Iwao

  Department of Applied Chemistry, Faculty of Engineering, Osaka University

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