title: The link in Linking.
abstract: We present 2 cases of the slow-fast form of AVNRT with initially narrow QRS complexes followed by sudden unexpected transition to persistently wide QRS complexes due to aberrant intraventricular conduction. Introduction of a properly timed extrastimulus in one case and critical oscillations in cycle length due to short-long coupling in the second case set the stage for the initial bundle branch block. However, persistence of the aberrancy pattern once the initial event abated was maintained by the "linking" phenomenon. Delayed, retrograde concealed activation from the contralateral bundle branch perpetuated the initial bundle branch block.
authors.affiliation: Heart Rhythm Service, Queen's University, Kingston, Ontario, Canada.
authors.forename: Jane C
authors.initials: JC
authors.lastname: Caldwell
authors.forename: Pablo A
authors.initials: PA
authors.lastname: Chiale
authors.forename: Mario D
authors.initials: MD
authors.lastname: Gonzalez
authors.forename: Adrian
authors.initials: A
authors.lastname: Baranchuk
keywords: Bundle Branch Block; Linking