Reverse atrioventricular reentrant tachycardia

Introduction Antidromic AV reentrant tachycardia (AAVRT) referred to as retrograde reentry tachycardia, also known as retrograde atrioventricular reentry tachycardia, atrioventricular reentrant tachycardia (atrioventricular reentrant tachycardia, The incidence of AVRT is second only to atrioventricular nodal reentry tachycardia (AVNRT), which accounts for approximately 30% of all supraventricular tachycardia. Atrioventricular reentry tachycardia (AVNRT), also referred to as bypass reentry tachycardia, is a common type of paroxysmal supraventricular tachycardia. In recent years, with the deepening of intracardiac electrophysiological examination and the application of radiofrequency ablation, people have a new understanding of AVNRT, and believe that the tachycardia reentry loop is not limited to the dense part of the atrioventricular node, but includes the room. The junction of the chamber and the surrounding room, so some scholars proposed to be renamed the atrioventricular junction reentry tachycardia (AVJRT).

Cause

The incidence of occult pre-excitation syndrome with AVRT is not clear. According to the tracking of 90 infants with pre-excitation syndrome, about 50% of patients with AVRT at the age of 30, AVRT patients with occult bypass involvement. From children to the elderly, younger people are more, young patients are often without organic heart disease, older patients can be accompanied by a variety of organic heart disease, most pre-excitation syndrome with AVRT patients Clinically, there is no basis for organic heart disease. A small number of patients may be associated with hypertrophic cardiomyopathy and rheumatic heart disease.

an examination

Related inspection

M-mode echocardiography (ME) ECG cardiovascular angiography cardiovascular MRI

1. The clinical manifestations of pre-transmission atrioventricular reentry tachycardia. The onset of AVRT is early, there may be palpitations during the attack, pre-cardiac discomfort or angina pectoris, dizziness, severe blood pressure reduction, shock and cardiac insufficiency, AVRT attack The heart rate can be slightly faster than AVNRT, but it is mostly in the same range. The heart rhythm is absolutely regular, the heart sound is strong and weak. When the tachycardia is over-expanded, the atrial expansion and anti-diuretic sodium excretion factor secretion increase, and the urinary tract can occur after the tachycardia is terminated. The clinical symptoms are related to the speed of tachycardia and whether hemodynamic disorder is caused. In addition, it is related to the recurrence of tolerance. The general heart rate is more than 160 beats/min, that is, palpitations, chest tightness, more than 200 times/min. There may be blood pressure drop, dizziness and even syncope.

2. The clinical manifestations of retrograde type atrioventricular reentry tachycardia The clinical symptoms and clinical course are both heavier and more dangerous than the pre-transmission atrioventricular reentry tachycardia. The heart rate at the onset is 140-250 beats/min. Often around 200 beats/min, the hemodynamic abnormalities of AAVRT are similar to ventricular tachycardia. When the heart rate is above 150 beats/min, obvious symptoms and hemodynamic disorders can occur, often with angina pectoris. Cardiac shock or syncope, severe cases can lead to ventricular arrhythmia, and even sudden death.

1. Diagnosis of anterior-type atrioventricular reentry tachycardia

(1) ECG characteristics:

1 timely atrial premature contraction (or ventricular premature contraction) spontaneous or electrical stimulation can induce and terminate the seizure.

2 The frequency is 150-240 times/min, mostly around 200 beats/min, and 38% of patients may have QRS electrical alternation.

3P-waves always appear after QRS waves, RP-/R block; no atrioventricular block.

(2) Atrioventricular reentry tachycardia with atrioventricular node double path is the most common, the frequency of AVRT is more than 180 times / min, if 150 times / min should pay attention to:

The 1 room has a double path and the AVRT is transmitted through the atrioventricular node.

2 should exclude the role of drugs, such as verapamil, propafenone, propranolol, etc. have an inhibitory effect on the atrioventricular node, can slow down its conduction, the frequency of AVRT is also slow, according to the medical history during the examination, medication And electrocardiogram, electrophysiological characteristics can make a more accurate diagnosis and differential diagnosis.

2. The diagnosis of retrograde atrioventricular reentry tachycardia is based on the clinical manifestations of the onset, the characteristics of electrocardiogram and the characteristics of cardiac electrophysiological examination to make a correct diagnosis.

Differential diagnosis

Differential diagnosis

Ectopic tachycardia: A rapid and basic regular ectopic rhythm that is short-lived or persistent, with sudden onset and termination, mostly referred to as paroxysmaltachycardia. The heart rate at the time of onset is generally 160 to 220 beats/min, but it is also as slow as 130 beats/min or as fast as 300 beats/min. Each episode can last less than 1 second or last for a few seconds, minutes, hours, or even days, automatically or after treatment. Some may have recurrent episodes, and the interval between the episodes varies.

Tachycardia: Adults have a heart rate of more than 100 beats per minute. The tachycardia is divided into two types: physiological pathology. When running, drinking, heavy physical labor and emotional agitation, the heart rate is accelerated to physiological tachycardia; if high fever, anemia, hyperthyroidism, hemorrhage, pain, hypoxia, heart failure and cardiomyopathy cause tachycardia, called pathological heartbeat Overspeed.

Rapid supraventricular arrhythmia: It is a common clinical cardiovascular emergency, including various supraventricular tachycardia and atrial flutter and atrial fibrillation. The virus infection, myocardial, inflammatory edema, immune allergic cell necrosis, massive fibrous tissue hyperplasia, interstitial capillary fibrosis, myocardial fibrosis and other pathological changes, in line with the traditional Chinese medicine heat poisoning lungs, lungs The function of the down-regulation is dysfunctional, the wet and dry sputum, the qi and blood running abnormally, and finally the pathological changes of the phlegm obstruction. Therefore, from the perspective of Chinese medicine, the disease is considered to be the evidence of the virtual standard, and the imaginary is secondary and the standard is the main.

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