Atypical atrioventricular Wenckebach periodicity caused by conduction through triple atrioventricular junctional pathway as a probable mechanism☆
Article Outline
Abstract
Electrocardiograms were taken from an 84-year-old man with right bundle branch block in whom atypical atrioventricular Wenckebach periodicity was frequently occurred. The electrocardiographic findings as mentioned below suggested that the atypical periodicity was caused by conduction through triple atrioventricular junctional pathways as a probable mechanism. When a P wave was blocked after a markedly prolonged PR interval of 0.64 s, the RP interval containing this blocked P wave ranged between 0.84 s and 0.86 s, and the next P wave was followed by a QRS complex of the same configuration, with the PR interval of 0.35 s. On the other hand, when a P wave was blocked after a PR interval of 0.49 s or 0.52 s, the RP interval containing this blocked P wave was comparatively long, ie, 0.95 s or 0.98 s, and the next P wave was followed by a QRS complex of somewhat different configuration showing borderline left axis deviation, with a shorter PR interval of 0.21 s or 0.23 s. These findings suggest that longitudinal dissociation occurred not only in the atrioventricular junction but also in the His bundle. This is the first report suggesting triple atrioventricular junctional pathways probably associated with longitudinal dissociation in the His bundle.
Keywords: Triple atrioventricular junctional pathways, atypical atrioventricular Wenckebach periodicity, longitudinal dissociation in the His bundle
No full text is available. To read the body of this article, please view the PDF online.
References
- . Dual atrioventricular nodal pathways: A reappraisal. PACE. 1982;5:72
- . Multiple pathways of conduction and reciprocal rhythm with interpolated ventricular premature systoles. Am Heart J. 1963;65:162
- . Ventricular echo beats in the human heart elicited by induced ventricular premature beats. Circulation. 1969;40:337
- . Two or more intraA-V nodal pathways in association with either a James or Kent extranodal bypath in 3 patients with paroxysmal supraventricular tachycardia. Br Heart J. 1973;35:113
- . Triple A-V nodal pathways in man?. J Electrocardiol. 1980;13:185
- Electrophysiologic study demonstrating triple antegrade AV nodal pathways in patients with spontaneous and/or induced supraventricular tachycardia. Am Heart J. 1982;103:168
- Multiple anterograde atrioventricular node pathways in patients with atrioventricular node reentrant tachycardia. J Am Coll Cardiol. 1996;28:725
- Multiple atrioventricular nodal pathways in humans: electrophysiologic demonstration and characterization. J Cardiovasc Electrophysiol. 1998;9:129
- Double reciprocation with double ventricular responses in a case of triple AV pathways. Shigaigaku. 1995;18:79; (in Japanese)
- . Longitudinal dissociation in the His bundle. Bundle branch block due to asynchronous conduction within the His bundle. Circulation. 1977;56:996
- Double His deflections caused by intrahisian conduction disturbance with longitudinal dissociation. Am J Cardiol. 1984;53:368
- Double ventricular response caused by longitudinal dissociation in the His bundle. J Electrocardiol. 2002;35:69
- . Atrioventricular Wenckebach periodicity in athletes: Influence of increased vagal tone on the occurrence of atypical periods. J Electrocardiol. 1987;20:272
- . Supraventricular tachycardia. In: ed 2. Clinical Cardiac Electrophysiology: Techniques and Interpretations. Philadelphia, PA: Lea & Febiger; 1993;p. 181
- Intraventricular trifascicular blocks. Am Heart J. 1969;78:450
- His electrocardiogram alternans reveal dual-wavefront inputs into longitudinal dissociation within the bundle of His. Circulation. 2001;104:832
☆ Reprint requests: Takakazu Katoh, MD, Katoh Cardiovascular Clinic, Taishogun 3-Chome 8-16, Ohtsu 520-2145, Japan.
PII: S0022-0736(02)30451-5
doi:10.1054/jelc.2003.036073
© 2003 Elsevier Science (USA). All rights reserved.
