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Orthodromic Tachycardia with Atrioventricular Dissociation: Evidence for a Nodoventricular (Mahaim) Fiber
Author(s) -
MANTOVAN ROBERTO,
VERLATO ROBERTO,
CORRADO DOMENICO,
BUIA GIANFRANCO,
HAISSAGUERRE MICHEL,
SHAH DIPEN C.
Publication year - 2000
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.1540-8159.2000.tb00813.x
Subject(s) - medicine , orthodromic , cardiology , tachycardia , qrs complex , left bundle branch block , sinus rhythm , antidromic , ventricular tachycardia , anesthesia , electrophysiology , atrial fibrillation , heart failure
We describe a patient in whom two tachycardias with AV dissociation were inducihle by ventricular extrastimulation. The first tachycardia was characterized by a narrow QRS preceded by a His deflection with an HV interval identical to that recorded in sinus rhythm (40 ms). Premature ventricular depolarization delivered when the His bundle was refractory advanced the next His deflection. These findings suggest the presence, of a nodoventricular bypass tract involved in an orthodromic tachycardia. The second tachycardia was induced after propafenone infusion and exhibited a wide QRS complex with left bundle branch block morphology; each ventricular complex was consistently associated with a His deflection with a HV interval of −15 ms. The second tachycardia may be considered to represent an antidromic tachycardia through the nodoventricular tract. However, a ventricular tachycardia cannot be excluded.