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Mechanism of Double Ventricular Response to a Single Atrial Extrastimulus in Patients with Wolff‐Parkinson‐White Syndrome
Author(s) -
MATSUHISA MOKUO,
SHIMOMURA KATSURO,
OHE TOHRU,
KAMAKURA SHIRO,
AIHARA NAOHIKO
Publication year - 1990
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.1540-8159.1990.tb02059.x
Subject(s) - medicine , accessory pathway , orthodromic , coronary sinus , cardiology , wpw syndrome , tachycardia , electrophysiology , anesthesia , atrial fibrillation , catheter ablation
The purpose of this sudy is to elucidate electrophysiological determinants of double ventricular response (DVR) to a single atrial extrastimulus in Wolff‐Parkinson‐White (WPW) syndrome. DVR was observed in 5 (3.4%) out of 146 consecutive patients with WPW syndrome. The site of accessory pathway was located in left lateral free wall in four patients and posterior septum in one. DVR was induced by extrastimulus from coronary sinus in four patients with left‐sided accessory pathway, and from both coronary sinus and high right atrium in a patient with septal accessory pathway. However, it was not possible to induce DVR from high right atrium in patients with left‐sided accessory pathway, because 50 to 80 ms are needed for intra‐atrial conduction from high right atrium to coronary sinus. Critical prolongation of normal AV conduction allowing DVR was seen in the slow pathway of AV node in four patients. In the remaining patients requisite conduction delay occurred in both AV node and His‐Purkinje system. Single right ventricular extrastimulus could easily elicit orthodromic AV reciprocating tachycardia or echo beat in four out of five patients and incremental ventricular stimulation induced it in the remaining patient, indicating the presence of retrograde block in the normal AV pathway. As requisites of DVR to a single atrial extrastimulus in WPW syndrome: (1) slow antegrade conduction and retrograde block in the normal AV pathway; and (2) stimulation site in the vicinity of accessory pathway, are needed.