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Linking: A Mechanism of Intermittent Preexcitation in the Wolff‐Parkinson‐White Syndrome
Author(s) -
MIDDLEKAUFF HOLLY R.,
STEVENSON WILLIAM G.,
KLITZNER THOMAS S.
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.tb06865.x
Subject(s) - medicine , accessory pathway , refractory period , cardiology , atrial fibrillation , effective refractory period , procainamide , anesthesia , catheter ablation
MIDDLEKAUFF, H.R., ET AL.: Linking: A Mechanism of Intermittent Preexcitation in the Wolff‐Parkinson‐White Syndrome. Intermittent preexcitation in the Wolff‐Parkinson‐White syndrome has been equated with a long accessory pathway refractory period and long R‐R interval between preexcited beats in atrial fibrillation and therefore a low risk for sudden death. A case of Wolff‐Parkinson‐White syndrome in which preexcitation became intermittent following procainamide infusion, with only moderate prolongation of the accessory pathway refractory period but marked prolongation of the shortest preexcited R‐R interval in atrial fibrillation, is described. Programmed ventricular and atrial stimulation demonstrated that intermittent preexcitation was caused by concealed conduction producing a linking phenomenon, facilitated by the antiarrhythmic drug. Linking due to concealed retrograde penetration of a propagated impulse into the accessory pathway may contribute to the disparity between accessory pathway refractory period and shortest preexcited R‐R interval in atrial fibrillation in some patients and may be a confounding factor in the interpretation of noninvasive tests of accessory pathway conduction.