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Alternating Sequence of Retrograde Atrial Activation in Patients with Dual AV Nodal Physiology
Author(s) -
Singer Igor,
Siddoway Lyle A.,
Guarnieri Thomas
Publication year - 1989
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/pace.1989.12.p1.80
Subject(s) - nodal , medicine , coronary sinus , tachycardia , atropine , accessory pathway , sequence (biology) , right atrium , cardiology , atrium (architecture) , anatomy , catheter ablation , biochemistry , ablation , biology , atrial fibrillation
Patients with dual AV nodal physiology have been demonstrated to have earliest retrograde activation sequence of the fast pathway in the lower septal right atrium and slow pathway in the proximal coronary sinus, and the posterior atrial septum. This case report describes a patient with dual AV nodal physiology demonstrating a dual sequence of retrograde activation with 2:1 block occurring in the fast pathway causing the conduction to proceed alternately via fast then slow pathway. This sequence was abolished by atropine allowing conduction to proceed via fast pathway. Surgical cure of patients with reentrant AV nodal tachycardia suggests the presence of two anatomically distinct AV nodal‐like path‐ways. This case report confirms this observation and further suggests preferential autonomic modulation of the fast pathway.