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. 1977 Jan;39(1):38–43. doi: 10.1136/hrt.39.1.38

Intermittent AV conduction disturbances in patients with AV nodal bypass tracts. Possible mechanisms of unusual variant of tachycardia-bradycardia syndrome.

A Castellanos, R J Sung, B Befeler, A Mayorga-Cortes, C Conde, S M Mallon, R J Myerburg
PMCID: PMC483192  PMID: 831736

Abstract

His bundle recordings were performed in 2 patients in whom AV nodal bypass tracts coexisted with intermittent AV conduction disturbances occurring below the site from which the His bundle deflection was recorded. Case 1 had: (a) tachycardia dependent right bundle-branch block, (b) persistent HV prolongation, and (c) bradycardia dependent AV block. Case 2 showed: (a) intra-atrial conduction delay, (b) tachcardia dependent left bundle-branch block with HV prolongation, (c) bradycardia dependent HV conduction disturbance, (d) tachycardia-bradycardia syndrome of an unusual type; the latter presumably resulted, during atrial flutter, from the alternation of rapid AH conduction through the bypass tract with intermittent (complete) distal His bundle block or bilateral bundle-branch block.

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Selected References

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  1. Anderson R. H., Becker A. E., Brechenmacher C., Davies M. J., Rossi L. The human atrioventricular junctional area. A morphological study of the A-V node and bundle. Eur J Cardiol. 1975 Jun;3(1):11–25. [PubMed] [Google Scholar]
  2. Aranda J., Castellanos A., Moleiro F., Befeler B. Effects of the pacing site on A-H conduction and refractoriness in patients with short P-R intervals. Circulation. 1976 Jan;53(1):33–39. doi: 10.1161/01.cir.53.1.33. [DOI] [PubMed] [Google Scholar]
  3. Befeler B., Castellanos A., Aranda J., Gutierrez R., Lazzara R. Intermittent bundle-branch block in patients with accessory atrio-His or atrio-AV nodal pathways. Variants of the Lown-Ganong-Levine syndrome. Br Heart J. 1976 Feb;38(2):173–179. doi: 10.1136/hrt.38.2.173. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bissett J. K., Thompson A. J., DeSoyza N., Murphy M. L. Atrioventricular conduction in patients with short PR intervals and normal QRS complexes. Br Heart J. 1973 Feb;35(2):123–127. doi: 10.1136/hrt.35.2.123. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Brechenmacher C. Atrio-His bundle tracts. Br Heart J. 1975 Aug;37(8):853–855. doi: 10.1136/hrt.37.8.853. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Brechenmacher C., Laham J., Iris L., Gerbaux A., Lenègre J. Etude histologique des voies anormales de conduction dans un syndrome de Wolff-Parkinson-White et dans un syndrome de Lown-Ganong-Levine. Arch Mal Coeur Vaiss. 1974 May;67(5):507–519. [PubMed] [Google Scholar]
  7. Caracta A. R., Damato A. N., Gallagher J. J., Josephson M. E., Varghese P. J., Lau S. H., Westura E. E. Electrophysiologic studies in the syndrome of short P-R interval, normal QRS complex. Am J Cardiol. 1973 Feb;31(2):245–253. doi: 10.1016/0002-9149(73)91037-0. [DOI] [PubMed] [Google Scholar]
  8. Castellanos A., Aranda J., Gutierrez R., Befeler B. Effects of pacing site on QRS morphology in Wolff-Parkinson-White syndrome, with special reference to 'pseudo-tachycardia-dependent block in accessory pathway and 'atrial gap'. Br Heart J. 1976 Apr;38(4):363–368. doi: 10.1136/hrt.38.4.363. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Castellanos A., Jr, Castillo C. A., Agha A. S., Tessler M. His bundle electrograms in patients with short P-R intervals, narrow QRS complexes, and paroxysmal tachycardias. Circulation. 1971 May;43(5):667–678. doi: 10.1161/01.cir.43.5.667. [DOI] [PubMed] [Google Scholar]
  10. Castellanos A., Jr, Myerburg R. J., Craparo K., Befeler B., Agha A. S. Factors regulating ventricular rates during atrial flutter and fibrillation in pre-excitation (Wolff-Parkinson-White) syndrome. Br Heart J. 1973 Aug;35(8):811–816. doi: 10.1136/hrt.35.8.811. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Castellanos A., Khuddus S. A., Sommer L. S., Sung R. J., Myerburg R. J. His bundle recordings in bradycardia-dependent AV block induced by premature beats. Br Heart J. 1975 Jun;37(6):570–575. doi: 10.1136/hrt.37.6.570. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Coumel P., Fabiato A., Waynberger M., Motte G., Slama R., Bouvrain Y. Bradycardia-dependent atrio-ventricular block. Report of two cases of A-V block elicited by premature beats. J Electrocardiol. 1971;4(2):168–177. doi: 10.1016/s0022-0736(71)80010-9. [DOI] [PubMed] [Google Scholar]
  13. Coumel P., Waynberger M., Slama R., Bouvrain Y. Le syndrome du P-R court, avec complexes QRS normal. Particularités électrocardiographiques. Arch Mal Coeur Vaiss. 1972 Feb;65(2):161–181. [PubMed] [Google Scholar]
  14. Denes P., Wu D., Rosen K. M. Demonstration of dual A-V pathways in a patient with Lown-Ganong-Levine syndrome. Chest. 1974 Mar;65(3):343–346. doi: 10.1378/chest.65.3.343. [DOI] [PubMed] [Google Scholar]
  15. 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]
  16. 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]
  17. HEJTMANCIK M. R., HERRMANN G. R., OATES J. R., RUNGE T. M. Paroxysmal pseudoventricular tachycardia and pseudoventricular fibrillation in patients with accelerated A-V conduction. Am Heart J. 1957 Feb;53(2):254–264. doi: 10.1016/0002-8703(57)90213-2. [DOI] [PubMed] [Google Scholar]
  18. JAMES T. N. Morphology of the human atrioventricular node, with remarks pertinent to its electrophysiology. Am Heart J. 1961 Dec;62:756–771. doi: 10.1016/0002-8703(61)90664-0. [DOI] [PubMed] [Google Scholar]
  19. Krishnaswami V., Geraci A. R. Accelerated A-V conduction associated with complete A-V block. Am Heart J. 1974 Oct;88(4):463–466. doi: 10.1016/0002-8703(74)90206-3. [DOI] [PubMed] [Google Scholar]
  20. MOE G. K., PRESTON J. B., BURLINGTON H. Physiologic evidence for a dual A-V transmission system. Circ Res. 1956 Jul;4(4):357–375. doi: 10.1161/01.res.4.4.357. [DOI] [PubMed] [Google Scholar]
  21. Narula O. S., Scherlag B. J., Samet P. Pervenous pacing of the specialized conducting system in man. His bundle and A-V nodal stimulation. Circulation. 1970 Jan;41(1):77–87. doi: 10.1161/01.cir.41.1.77. [DOI] [PubMed] [Google Scholar]
  22. Rosen K. M., Mehta A., Miller R. A. Demonstration of dual atrioventricular nodal pathways in man. Am J Cardiol. 1974 Feb;33(2):291–294. doi: 10.1016/0002-9149(74)90292-6. [DOI] [PubMed] [Google Scholar]
  23. Rosenbaum M. B., Elizari M. V., Lázzari J. O., Halpern M. S., Nau G. J., Levi R. J. The mechanism of intermittent bundle branch block: relationship to prolonged recovery, hypopolarization and spontaneous diastolic depolarization. Chest. 1973 May;63(5):666–677. doi: 10.1378/chest.63.5.666. [DOI] [PubMed] [Google Scholar]
  24. Wellens H. J. Contribution of cardiac pacing to our understanding of the Wolff-Parkinson-White syndrome. Br Heart J. 1975 Mar;37(3):231–241. doi: 10.1136/hrt.37.3.231. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Wit A. L., Weiss M. B., Berkowitz W. D., Rosen K. M., Steiner C., Damato A. N. Patterns of atrioventricular conduction in the human heart. Circ Res. 1970 Sep;27(3):345–359. doi: 10.1161/01.res.27.3.345. [DOI] [PubMed] [Google Scholar]

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