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        발작성 상심실성 빈맥환자에 있어서 각종 항부정맥제에 대한 전기생리학적 검사

        김성순(Sung Soon Kim),박승정(Seung Jung Park),장양수(Yang Soo Jnag),탁승제(Seung Jea Tahk),심원흠(Won Heum Shim),조승연(Seung Yun Cho),김현승(Hyun Seung Kim) 대한내과학회 1991 대한내과학회지 Vol.40 No.3

        N/A Electrophysiologyc studies (EPS) and serial drug testing were performed in 100 consecutive patients with paroxysmal supraventricular tachycardia (PSVT) but without ventricular preexcitation. All patients had a history of electrocardiographically-documented PSVT. Two patients with concealed bypass tract (CBT) had Ebstein's amomally, and 1 patient with atrial reentrant SVT had mitral stenosis. The remaining patients had structurally normal hearts. Ninety-eight patients had inducible sustained PSVT during the control study. Two had only nonsustained PSVT. EPS revealed AV reentrance utilizing concealed bypass tract (CBT) in 63 patients (Group I), A V nodal reentrance in 36 (Group II), and atrial reentrance in 1. The location of the accessory pathway in Group I was left free wall in 45 (72%.), posteroseptal in 12 (19%), right free wall in 4 (6%), and anteroseptal in 2(3%) patients. Eight patients had associated anterograde dual AV nodal pathways. Five of them utilized slow AV nodal pathway for anterograde conduction during AV reentrant SVT. Single and double atrial extrastimulation demonstrated discontinuous AV nodal conduction curve in 28 patients (77%) in Group II, and the remaining 8 had a continuous AV nodal conduction curve. Serial daily SVT induction was attempted after intravenous ad- ministration of procainamide 20 mg/kg, verapamil 0.15 mg/kg, digoxin 0.75 mg, and proplanolol 0.15 mg/kg. In Group I, procainamide showed drug response in 40/49 (82%), flecainide in 24/32 (75%), verapamil in 36/41 (89%), digoxin in 5/20 (25%), and digoxin + propranolol in 9/18 (50%). In Group II, procainamide showed drug response in 21/24 (88%), flecainide in 10/11 (91%), verapamil in 20/28 (95%), digoxin in 12/20 (60%), and digoxin + propranol l in 11/15 (73%) patients. In conclusion, AV reentrant SVT utilizing CBT is the most common mechanism (63%) of PSVT in symptomatic Korean patients. Serial EPS with multiple drugs is very useful to define effective dugs in patients with symptomatic PSVT. Our data on serial drug testing might help us select the drug for those who want to be treated without invasive EPS.

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