심실조기흥분증후군에서 역방향 방실회귀성빈맥의 임상적 및 전기생리학적 특성

Abstract

Background：Antidromic reentrant tachycardia(ART), in which an accessory atrioventricular pathway is used as the anterograde limb of an atrioventricular reentrant tachycardia, has been documented clinically in less than 10% of patients with the Wolff-Parkinson-White(WPW) syndrome. The wide QRS complex makes the distinction between antidromic AV reentrant tachycardia and ventricular tachycardia somewhat difficult. The purpose of this study is to evaluate the clinical and electrophysiologic characteristics of the antidromic reentrant tachycardia. Methods and Results：During the electrophysiologic study of 355 patients, from December 1986 to April 1995, referred for evaluation of Wolff-Parkinson-White syndrome, 18(5.1%) patients had preexcited reciprocating tachycardia. 1) The age of the antidromic reentrant tachycardia patients ranged from 15 to 53 years(28±12), and the mean age was younger than that of orthodromic reentrant tachycardia(ORT) patients(p<0.05). 2) Thirteen were male patients, five were females. 3) There were associated heart diseases in 3 cases. Two patients had Ebstein’s anomaly and one had valvular heart disease. 4) The locations of accessory pathways(APs) documented on surface ECG were 7 left side(39%), 9 right side(50%), 1 posteroseptal side(5.5%) and 1 anteroseptal side. 5) Multiple bypass tracts were documented by electrophysiologic study in 7/18(38.9%) cases with ART, more common than cases with ORT(20/337(5.9%))(p<0.05). 6) 25 accessory pathways were documented by EPS in 18 patients(10 left side, 11 right side, 2 posteroseptal side and 2 anteroseptal side). ART patients had more right sided AP(11/25, 44%) than those with ORT(98/357, 27.5%), but ART patients had less posteroseptal AP(2/25, 8%) than those with ORT(63/357, 17.6%).