title: Concealed accessory pathway with long conduction times and incremental properties: a case report.
abstract: Concealed AP with Slow and Incremental Conduction. We report a peculiar form of permanent junctional reciprocating tachycardia that occurs only during daytime and physical activity. ECG obtained during tachycardia showed an unusual progressive shortening of the ventriculoatrial (VA) interval that was maximal at the first complex and shortest at the last one before block occurred, always at the accessory pathway level. This phenomenon has not been previously described and appears to be a reverse type of Wenckebach block. It was observed during salvos of spontaneous tachycardia and could be reproduced by right ventricular pacing. The accessory pathway was ablated successfully at the right posteroseptal region, close to the coronary sinus ostium. After ablation, there was no VA conduction, and tachycardia did not recur during a 9-month follow-up period.
authors.affiliation: Department of Cardiology, Hospital Vera Cruz, Belo Horizonte, Minas Gerais, Brazil. edstern@gold.com.br
authors.forename: E B
authors.initials: EB
authors.lastname: Sternick
authors.forename: L M
authors.initials: LM
authors.lastname: Gerken
authors.forename: E G
authors.initials: EG
authors.lastname: God
mesh_terms: D000328:Adult; D017115:Catheter Ablation; D002940:Circadian Rhythm; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D006327:Heart Block / Q000209:etiology; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D013610:Tachycardia / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D013997:Time Factors