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. 1980 Jan;43(1):7–13. doi: 10.1136/hrt.43.1.7

'Dual atrioventricular nodal pathways" in patients with Wolff-Parkinson-White syndrome.

E L Pritchett, E N Prystowsky, D G Benditt, J J Gallagher
PMCID: PMC482235  PMID: 7356864

Abstract

'Dual atrioventricular nodal pathways" were found in five patients who also had the Wolff-Parkinson-White syndrome. All five patients had a re-entrant tachycardia that used the atrioventricular node for conduction in the anterograde direction and an accessory atrioventricular pathway for conduction in the retrograde direction. One of the patients also had a re-entrant tachycardia that originated within the atrium or the atrioventricular node. Dual atrioventricular nodal pathways were identified in three of the five patients during their first electrophysiological study because the effective refractory period of the accessory atrioventricular pathway in the anterograde direction was longer than the effective refractory period of the fast atrioventricular nodal pathway. In the other two patients the dual atrioventricular nodal pathways were found only after operative division of an accessory atrioventricular pathway. Re-entrant tachycardia that uses an accessory pathway may be cured by operative division of the accessory pathway. Tachycardia resulting from re-entry within the atrioventricular node cannot be cured by an operation unless the normal conduction system is divided and a permanent pacemaker implanted. These five patients indicate the importance of determining the aetiology of tachycardia by studying the tachycardia itself and not only the type of atrioventricular conduction present.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Amat-y-Leon F., Wyndham C., Wu D., Denes P., Dhingra R. C., Rosen K. M. Participation of fast and slow A-V nodal pathways in tachycardias complicating the Wolff-Parkinson-White syndrome. Report of a case. Circulation. 1977 Apr;55(4):663–668. doi: 10.1161/01.cir.55.4.663. [DOI] [PubMed] [Google Scholar]
  2. Anderson R. H., Becker A. E., Brechenmacher C., Davies M. J., Rossi L. Ventricular preexcitation. A proposed nomenclature for its substrates. Eur J Cardiol. 1975 Jun;3(1):27–36. [PubMed] [Google Scholar]
  3. Benditt D. G., Pritchett E. L., Gallagher J. J. Spectrum of regular tachycardias with wide QRS complexes in patients with accessory atrioventricular pathways. Am J Cardiol. 1978 Nov;42(5):828–838. doi: 10.1016/0002-9149(78)90104-2. [DOI] [PubMed] [Google Scholar]
  4. Bigger J. T., Jr, Goldreyer B. N. The mechanism of supraventricular tachycardia. Circulation. 1970 Oct;42(4):673–688. doi: 10.1161/01.cir.42.4.673. [DOI] [PubMed] [Google Scholar]
  5. Coumel P., Attuel P. Reciprocating tachycardia in overt and latent preexcitation. Influence of functional bundle branch block on the rate of the tachycardia. Eur J Cardiol. 1974 Apr;1(4):423–436. [PubMed] [Google Scholar]
  6. Denes P., Wu D., Dhingra R. C., Chuquimia R., Rosen K. M. Demonstration of dual A-V nodal pathways in patients with paroxysmal supraventricular tachycardia. Circulation. 1973 Sep;48(3):549–555. doi: 10.1161/01.cir.48.3.549. [DOI] [PubMed] [Google Scholar]
  7. Denes P., Wu D., Dhingra R., Amat-y-Leon F., Wyndham C., Rosen K. M. Dual atrioventricular nodal pathways. A common electrophysiological response. Br Heart J. 1975 Oct;37(10):1069–1076. doi: 10.1136/hrt.37.10.1069. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Denes P., Wu D., Dhingra R., Pietras R. J., Rosen K. M. The effects of cycle length on cardiac refractory periods in man. Circulation. 1974 Jan;49(1):32–41. doi: 10.1161/01.cir.49.1.32. [DOI] [PubMed] [Google Scholar]
  9. Farshidi A., Josephson M. E., Horowitz L. N. Electrophysiologic characteristics of concealed bypass tracts: clinical and electrocardiographic correlates. Am J Cardiol. 1978 May 22;41(6):1052–1060. doi: 10.1016/0002-9149(78)90857-3. [DOI] [PubMed] [Google Scholar]
  10. Gallagher J. J., Gilbert M., Svenson R. H., Sealy W. C., Kasell J., Wallace A. G. Wolff-Parkinson-White syndrome. The problem, evaluation, and surgical correction. Circulation. 1975 May;51(5):767–785. doi: 10.1161/01.cir.51.5.767. [DOI] [PubMed] [Google Scholar]
  11. Gallagher J. J., Pritchett E. L., Benditt D. G., Tonkin A. M., Campbell R. W., Dugan F. A., Bashore T. M., Tower A., Wallace A. G. New catheter techniques for analysis of the sequence of retrograde atrial activation in man. Eur J Cardiol. 1977 Sep-Oct;6(1):1–14. [PubMed] [Google Scholar]
  12. Gallagher J. J., Pritchett E. L., Sealy W. C., Kasell J., Wallace A. G. The preexcitation syndromes. Prog Cardiovasc Dis. 1978 Jan-Feb;20(4):285–327. doi: 10.1016/0033-0620(78)90015-4. [DOI] [PubMed] [Google Scholar]
  13. Gallagher J. J. Surgical treatment of arrhythmias: current status and future directions. Am J Cardiol. 1978 May 22;41(6):1035–1044. doi: 10.1016/0002-9149(78)90855-x. [DOI] [PubMed] [Google Scholar]
  14. Goldreyer B. N., Bigger J. T., Jr Site of reentry in paroxysmal supraventricular tachycardia in man. Circulation. 1971 Jan;43(1):15–26. doi: 10.1161/01.cir.43.1.15. [DOI] [PubMed] [Google Scholar]
  15. Goldreyer B. N., Damato A. N. The essential role of atrioventricular conduction delay in the initiation of paroxysmal supraventricular tachycardia. Circulation. 1971 May;43(5):679–687. doi: 10.1161/01.cir.43.5.679. [DOI] [PubMed] [Google Scholar]
  16. Pritchett E. L., Gallagher J. J., Scheinman M., Smith W. M. Determinants of antegrade echo zone in the Wolff-Parkinson-White syndrome. Circulation. 1978 Apr;57(4):671–677. doi: 10.1161/01.cir.57.4.671. [DOI] [PubMed] [Google Scholar]
  17. Pritchett E. L., Tonkin A. M., Dugan F. A., Wallace A. G., Gallagher J. J. Ventriculo-atrial conduction time during reciprocating tachycardia with intermittent bundle-branch block in Wolff-Parkinson-White syndrome. Br Heart J. 1976 Oct;38(10):1058–1064. doi: 10.1136/hrt.38.10.1058. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Prystowsky E. N., Pritchett L. C., Smith W. M., Wallace A. G., Sealy W. C., Gallagher J. J. Electrophysiologic assessment of the atrioventricular conduction system after surgical correction of ventricular preexcitation. Circulation. 1979 Apr;59(4):789–796. doi: 10.1161/01.cir.59.4.789. [DOI] [PubMed] [Google Scholar]
  19. Sellers T. D., Jr, Gallagher J. J., Cope G. D., Tonkin A. M., Wallace A. G. Retrograde atrial preexcitation following premature ventricular beats during reciprocating tachycardia in the Wolff-Parkinson-White syndrome. Eur J Cardiol. 1976 Sep;4(3):283–294. [PubMed] [Google Scholar]
  20. Smith W. M., Pritchett E. L., Campbell R. W., Gallagher J. J. An interactive computer program for measurement of data obtained using the extra-stimulus technique during electrode-catheter studies. Comput Biomed Res. 1977 Dec;10(6):595–603. doi: 10.1016/0010-4809(77)90015-5. [DOI] [PubMed] [Google Scholar]
  21. Spurrell R. A., Krikler D., Sowton E. Two or more intra AV nodal pathways in association with either a James or Kent extranodal bypass in 3 patients with paroxysmal supraventricular tachycardia. Br Heart J. 1973 Feb;35(2):113–122. doi: 10.1136/hrt.35.2.113. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Svenson R. H., Miller H. C., Gallagher J. J., Wallace A. G. Electrophysiological evaluation of the Wolff-Parkinson-White syndrome: problems in assessing antegrade and retrograde conduction over the accessory pathway. Circulation. 1975 Oct;52(4):552–562. doi: 10.1161/01.cir.52.4.552. [DOI] [PubMed] [Google Scholar]
  23. Touboul P., Huerta F., Porte J., Delahaye J. P. Reciprocal rhythm in patients with normal electrocardiogram: Evidence for dual conduction pathways. Am Heart J. 1976 Jan;91(1):3–10. doi: 10.1016/s0002-8703(76)80427-9. [DOI] [PubMed] [Google Scholar]
  24. Wellens H. J., Durrer D. The role of an accessory atrioventricular pathway in reciprocal tachycardia. Observations in patients with and without the Wolff-Parkinson-White syndrome. Circulation. 1975 Jul;52(1):58–72. doi: 10.1161/01.cir.52.1.58. [DOI] [PubMed] [Google Scholar]
  25. Wu D., Denes P., Amat-y-Leon F., Dhingra R., Wyndham C. R., Bauernfeind R., Latif P., Rosen K. M. Clinical, electrocardiographic and electrophysiologic observations in patients with paroxysmal supraventricular tachycardia. Am J Cardiol. 1978 May 22;41(6):1045–1051. doi: 10.1016/0002-9149(78)90856-1. [DOI] [PubMed] [Google Scholar]

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