“Incessant” Atrioventricular (AV) Reciprocating Tachycardia Utilizing Left Lateral AV Bypass Pathway with a Long Retrograde Conduction Time
Corresponding Author
KEN OKUMURA
Department of Medicine and the Cardiovascular Research and Training Center, The University of Alabama at Birmingham. Birmingham, Alabama
Address for reprints: Ken Okumura. M.D., UAB Medical Center, Room 336 LHR, University Station, Birmingham. Alabama 35294 USA.Search for more papers by this authorRICHARD W. HENTHORN
Department of Medicine and the Cardiovascular Research and Training Center, The University of Alabama at Birmingham. Birmingham, Alabama
Search for more papers by this authorANDREW E. EPSTEIN
Department of Medicine and the Cardiovascular Research and Training Center, The University of Alabama at Birmingham. Birmingham, Alabama
Search for more papers by this authorVANCE J. PLUMB
Department of Medicine and the Cardiovascular Research and Training Center, The University of Alabama at Birmingham. Birmingham, Alabama
Search for more papers by this authorALBERT L. WALDO
Department of Medicine and the Cardiovascular Research and Training Center, The University of Alabama at Birmingham. Birmingham, Alabama
Search for more papers by this authorCorresponding Author
KEN OKUMURA
Department of Medicine and the Cardiovascular Research and Training Center, The University of Alabama at Birmingham. Birmingham, Alabama
Address for reprints: Ken Okumura. M.D., UAB Medical Center, Room 336 LHR, University Station, Birmingham. Alabama 35294 USA.Search for more papers by this authorRICHARD W. HENTHORN
Department of Medicine and the Cardiovascular Research and Training Center, The University of Alabama at Birmingham. Birmingham, Alabama
Search for more papers by this authorANDREW E. EPSTEIN
Department of Medicine and the Cardiovascular Research and Training Center, The University of Alabama at Birmingham. Birmingham, Alabama
Search for more papers by this authorVANCE J. PLUMB
Department of Medicine and the Cardiovascular Research and Training Center, The University of Alabama at Birmingham. Birmingham, Alabama
Search for more papers by this authorALBERT L. WALDO
Department of Medicine and the Cardiovascular Research and Training Center, The University of Alabama at Birmingham. Birmingham, Alabama
Search for more papers by this authorSupported in part by NIH NHLBI grants: SCOR in Ischemic Heart Disease Grant 2P50HL17667 and 5RO1HL29381-03.
Abstract
Two patients with incessant or nearly incessant episodes of atrioventricular (AV) reciprocating tachycardia were studied and were found to be unique because of the location of a slowly conducting retrograde AV bypass pathway in the left lateral position. During the tachycardia in both patients, negative P waves were present not only in ECG leads II, III, and aVF. but also in leads I and aVL. The R-P/P-R ratios were 1.3 and 1.9, respectively. Cardiac electrophysiologic study revealed that in both tachycardias, retrograde ventriculoatrial conduction occurred utilizing a concealed left lateral AV bypass pathway with a long conduction time. Verapamil prolonged conduction over the AV bypass pathway in both patients. One patient was successfully treated with oral verapamiL The other patient underwent successful surgical interruption of the AV bypass pathway.
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