Abstract
The case of a patient suffering from incessant supraventricular tachycardia is presented. The electrophysiological study showed the presence of an accessory atrioventricular (A-V) bundle with nodal-like properties and long conduction times. This structure was used as the retrograde arm of the tachycardia circuit. Tachycardia was intermittent at rest, but had a sustained character during slight exercise. Administration of atropine and isoproterenol failed to sustain the arrhythmia and spontaneous initiation during sinus rhythm was no longer observed. During handgrip exercise a sustained tachycardia developed immediately. During ventricular stimulation a dual atrial response to a single paced ventricular premature beat was repeatedly observed, proving the availability of two separate A-V pathways for retrograde conduction. The case illustrates the labile nature of this type of accessory pathway, and suggests that autonomic changes can play an important role in the initiation, maintenance, termination, or even spontaneous cure of tachycardia in patients with this anomaly.
References
Jul 1, 1979·The American Journal of Cardiology·P DenesK M Rosen
Sep 1, 1979·The American Journal of Cardiology·M L EpsteinD G Benditt
Nov 1, 1979·The American Journal of Cardiology·J FarréH J Wellens
May 6, 1967·Nature·A M LandsT G Brown
May 1, 1980·Circulation·D L RossH J Wellens
Citations
Sep 1, 1990·Journal of the American College of Cardiology·F E CruzH J Wellens
Sep 1, 1984·Journal of the American College of Cardiology·G CritelliL Rossi
Dec 1, 1985·Journal of the American College of Cardiology·A CastellanosL Zaman
Jun 1, 1983·British Heart Journal·G CritelliJ Gallagher
Jun 1, 1984·The American Journal of Cardiology·B PortilloA Castellanos
Mar 1, 1981·The American Journal of Cardiology·P BrugadaH J Wellens
May 1, 1993·American Heart Journal·H J ChangD Wu
May 1, 1992·Pacing and Clinical Electrophysiology : PACE·M E CainB D Lindsay
Sep 1, 1994·Journal of Cardiovascular Electrophysiology·A StankeJ A Salerno-Uriarte
May 1, 1988·Clinical Cardiology·F Perticone, S A Marsico
Mar 1, 1983·Circulation·G CritelliJ J Gallagher
May 1, 1986·Pacing and Clinical Electrophysiology : PACE·K OkumuraA L Waldo
Jan 1, 1986·Pacing and Clinical Electrophysiology : PACE·N C SaoudiR J Myerburg
Nov 1, 1988·Pacing and Clinical Electrophysiology : PACE·A FujikiS Sasayama
Sep 1, 1996·Journal of Cardiovascular Electrophysiology·D J CallansF E Marchlinski
May 10, 2005·Journal of Cardiovascular Electrophysiology·Gian-Battista ChierchiaPedro Brugada
Nov 1, 1983·Pacing and Clinical Electrophysiology : PACE·R J Sung