His Bundle Recordings in Patients with Reciprocating Tachycardias and Wolff-Parkinson-White Syndrome

The mechanisms of reciprocating tachycardias were studied in three patients with WPW syndrome using the catheter technic of His bundle recordings. In the first case it could not be determined with certainty whether the tachycardias involved two anatomically independent fascicles or a single longitudinally dissociated pathway. They were terminated by carotid sinus pressure, which caused A-V nodal block, or by properly timed atrial stimuli, which interrupted the circuit. Short-lived paroxysms of atrial fibrillation in cases 1 and 2 were most probably related to atrial vulnerability. In case 3 there were three types of QRS complexes in lead II representing (a) exclusive His bundle conduction, (b) simultaneous His and Kent bundle conduction, and (c) coexisting His and infra-nodal preferential (Mahaim fiber[?]) conduction. This patient also had three types of reciprocating tachycardias-two of ventricular, and one of atrial origin. The reciprocating circuit probably involved the three pathways.