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Reciprocating Tachycardia Due to a Right‐Sided Unidirectional Retrograde Anomalous Pathway (URAP) *
Author(s) -
ORZAN FULVIO,
GILLETTE PAUL C.
Publication year - 1978
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1978.tb03485.x
Subject(s) - medicine , accessory pathway , tachycardia , cardiology , delta wave , reentry , intracardiac injection , reciprocating motion , supraventricular tachycardia , electrocardiography , electrophysiology , bundle of his , electrical conduction system of the heart , anesthesia , catheter ablation , atrial fibrillation , mechanical engineering , eye movement , gas compressor , engineering , non rapid eye movement sleep , ophthalmology
An 8 year‐old boy had extensive electrophysiological evaluation of his recurrent supraventricular tachycardias. His EGG never showed delta waves but intracardiac stimulation and recording disclosed the following: (1) eccentric retrograde atrial activation; (2) increased cycle length and retrograde conduction time following the development of right bundle‐branch block; (3) constant retrograde conduction time for increasingly premature ventricular stimuli; (4) atrial captures by ventricular stimuli when the atrioventricular‐His pathways were refractory; and (5) no delta waves upon stimulation of the atrial input site of the anomalous pathway. A diagnosis of reciprocating tachycardia involving retrograde conduction through an accessory pathway was made. Reciprocating tachycardias involving a unidirectional retrograde anomalous pathway can be easily misdiagnosed as atrioventricular node reentrant tachycardias if no evidence of preexcitation can be found, particularly if the anomalous pathway is on the right side. In order to exclude the participation of a concealed unidirectional anomalous pathway in a patient's reentry tachycardia, a complete map must be made of right and left atrial endocardial activity.