Retrograde dual atrioventricular nodal pathway in patients with atrioventricular reciprocating tachycardia using concealed accessory pathways

• Published in: International journal of cardiology Vol. 26; no. 1; pp. 67 - 74
• Main Authors: HLUCHY, J, MILOVSKY, V
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 1990; Elsevier Science
• Subjects: Adolescent; Ajmaline - pharmacology; Atrioventricular Node - drug effects; Atrioventricular Node - physiopathology; Atrioventricular reciprocating tachycardia; Biological and medical sciences; Cardiac dysrhythmias; Cardiology. Vascular system; Concealed accessory pathway; Electrophysiology; Heart; Heart Conduction System - physiopathology; Humans; Male; Medical sciences; Retrograde dual atrioventricular nodal pathway; Tachycardia, Atrioventricular Nodal Reentry - physiopathology; Tachycardia, Supraventricular - physiopathology; Concealed accessory pathway; Atrioventricular reciprocating tachycardia; Retrograde dual atrioventricular nodal pathway; Heart; Human; Electrodiagnosis; Retrograde conduction; Arrhythmia; Electrocardiography; Cardiovascular disease; Accessory bundle; Paroxysmal supraventricular tachycardia; Excitability disorder
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/0167-5273(90)90249-5

We present electrophysiological studies in two patients with atrioventricular reciprocating tachycardias. The first patient had anterograde dual atrioventricular nodal pathways with a right-sided concealed accessory pathway. The retrograde atrioventricular nodal pathway showed evidence suggestive of slow pathway properties. After block was induced with ajmaline in the accessory pathway, a typical pattern of discontinuous retrograde atrioventricular nodal conduction curves was recognized. We then observed three types of induced atrioventricular reentry. The other patient had continuous anterograde atrioventricular nodal conduction, a fast-conducting retrograde atrioventricular nodal pathway and a left-sided concealed accessory pathway. After refractoriness had been induced in the accessory pathway with ajmaline, a typical pattern of retrograde dual atrioventricular nodal pathways was recognized, and it proved impossible to induce atrioventricular nodal echoes. Induction of block or impairment of conduction with ajmaline in the concealed accessory pathway proved helpful in the disclosure of retrograde dual atrioventricular nodal pathways by means of the ventricular extrastimulus method.