Alterations of orthodromic circus movement tachycardia by dual atrioventricular nodal pathways in a patient with Wolff-Parkinson-White syndrome.
In a patient with a left sided accessory pathway (AP) three different types of orthodromic circus movement tachycardia were observed: (1) narrow QRS complex tachycardia with a stable cycle length (CL); (2) wide QRS complex tachycardia with a functional bundle branch block ipsilateral to the AP, which, paradoxically, had a shorter CL. The decrease in CL was due to a decrease of the AH interval; and (3) narrow QRS complex tachycardia with alternating CL, due to alternations of the AH interval. These phenomena were attributed to a concomitant dual atrioventricular (AV) node, which was eventually proven after successful catheter ablation of the AP.
Kreiner
G
G
Second Department of Medicine/Division of Cardiology, University of Vienna, Austria.
Heinz
G
G
Siostrzonek
P
P
Radosztics
S
S
Gössinger
H D
HD
D000368:Aged; D001283:Atrioventricular Node / Q000002:abnormalities* / Q000503:physiopathology* / Q000601:surgery; D002036:Bundle of His / Q000503:physiopathology; D002037:Bundle-Branch Block / Q000503:physiopathology; D017115:Catheter Ablation; D003331:Coronary Vessels / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D013610:Tachycardia / Q000503:physiopathology*; D014927:Wolff-Parkinson-White Syndrome / Q000503:physiopathology* / Q000601:surgery