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Quintuple pathways participating in three distinct types of atrioventricular reciprocating tachycardia in a patient with Wolff-Parkinson-White syndrome.

Abstract
Electrophysiologic studies were performed in a patient with recurrent supraventricular tachyarrhythmias. Sinus and paced atrial beats had QRS complexes characteristic of atrioventricular (A-V) conduction through a manifest left lateral accessory pathway (Wolff-Parkinson-White syndrome, type A). Three distinct types of A-V reciprocating tachycardia and three different modes of retrograde atrial activation were demonstrated. Type 1 tachycardia involved the slow A-V nodal pathway and a second (left lateral or left paraseptal) accessory A-V pathway capable of retrograde conduction only. Type 2 tachycardia was of the slow-fast A-V nodal pathway type. Type 3 tachycardia involved in heretofore undescribed circuit in that retrograde conduction occurred through an accessory A-V pathway with long retrograde conduction times and anterograde conduction through both the manifest left lateral accessory A-V pathway and fast A-V nodal pathway. Premature ventricular beats delivered late in the cycle of this tachycardia advanced (but did not change) the retrograde atrial activity without affecting the timing of the corresponding anterograde H deflection. In summary, this patient had five (three accessory and two intranodal) pathways participating in three different types of A-V reciprocating tachycardia; the recurrence of these were prevented with oral amiodarone therapy.
AuthorsB Portillo, N Portillo-Leon, L Zaman, A Castellanos
JournalThe American journal of cardiology (Am J Cardiol) Vol. 50 Issue 2 Pg. 347-52 (Aug 1982) ISSN: 0002-9149 [Print] United States
PMID7102562 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Amiodarone
Topics
  • Aged
  • Amiodarone (therapeutic use)
  • Atrioventricular Node (physiopathology)
  • Electrocardiography
  • Electrophysiology
  • Heart Conduction System (physiopathology)
  • Humans
  • Male
  • Tachycardia (drug therapy, physiopathology)
  • Wolff-Parkinson-White Syndrome (drug therapy, physiopathology)

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