[Automatic modulation of refractoriness of His-Purkinje system during atrioventricular nodal reentrant tachycardia].
OBJECTIVE
To illustrate the automatic modulation of refractoriness of His-Purkinje system during atrioventricular nodal reentrant tachycardia (AVNRT) and to discuss the possible mechanisms.


METHODS
Programmed electrical stimulations were performed in high right atrium (HRA) in 8 patients with AVNRT before ablation to induce tachycardia and electrocardiagraphic recordings were done synchronically when AVNRT appeared.


RESULTS
All the patients had 2:1 atrioventricular (A-V) conduction when AVNRT began, 2 of whom were blocked below His bundle, 5 above His bundle and 1 unclear. After a duration of 14.03 +/- 10.03 s of 2:1 A-V conduction, 1:1 A-V conduction with bundle banch block appeared, 3 of which were right bundle branch block (RBBB), 3 left bundle branch block (LBBB), and 2 with both. Bundle branch block disappeared after a duration of 6.87 +/- 11.26 s.


CONCLUSIONS
Effective refractory period (ERP) of His-Purkinje system at the beginning of AVNRT was modulated automatically within less than 30-60 s and thus facilitated nodal-ventricular conduction. The mechanism of this is electrical remodeling.
Chen
M
M
Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China.
Cao
K
K
Shan
Q
Q
Zou
J
J
Li
W
W
Liao
M
M
Huang
Y
Y
D000328:Adult; D000368:Aged; D002036:Bundle of His / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011690:Purkinje Fibers / Q000503:physiopathology*; D012032:Refractory Period, Electrophysiological; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000503:physiopathology*