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[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.


CONCLUSION
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.