Demonstration of bidirectional dual A-V nodal pathways in the same patient.
In a patient with documented paroxysmal junctional tachycardia (PJT) electrophysiologic studies were performed using an extrastimulus technique. At an A1-A2 interval of 360 msec, atrial extrastimulus revealed sudden prolongation of an A2-H2 interval from 370 to 540 msec and PJT ensued. This finding was consistent with antegrade dual A-V nodal pathways. On the other hand, at a V1-V2 interval of 540 msec, ventricular estrastimulus showed a jump in ventriculo-atrial (V-A) conduction time with evidence of delay in the A-V node from 285 to 565 msec and a ventricular echo followed. This finding was consistent with retrograde dual A-V nodal pathways. Mechanisms of bidirectional dual A-V nodal pathways are discussed.
D000368:Aged; D001283:Atrioventricular Node / Q000503:physiopathology*; D002036:Bundle of His / Q000503:physiopathology; D006328:Cardiac Catheterization; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D013614:Tachycardia, Paroxysmal / Q000503:physiopathology*