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(Circulation. 1971;43:15.)
© 1971 American Heart Association, Inc.

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Site of Reentry in Paroxysmal Supraventricular Tachycardia in Man

BRUCE N. GOLDREYER M.D.¹ J. THOMAS BIGGER JR. M.D.¹

¹ From the Departments of Medicine and Pharmacology, College of Physicians and Surgeons, Columbia University, New York, New York, and the Medical Service, The Presbyterian Hospital in the City of New York.

His bundle recordings during spontaneous and induced episodes of paroxysmal supraventricular tachycardia (SVT) demonstrated that the site of reentry responsible for this arrhythmia was in the A-V node. In five patients studied, A-V conduction time and refractory periods were normal, but atrial premature depolarizations (APD) within a portion of the relative refractory period of the A-V node consistently produced atrial reentry—echoes or sustained SVT. In two patients, APDs falling within the A-V effective refractory period failed to excite the His bundle but still reentered within the A-V node and began SVT. It was noted that the various relationships between atrial and ventricular depolarizations on the surface ECG did not reflect different mechanisms for SVT, but only variations in A-V nodal conduction time.

Key Words: Paroxysmal atrial tachycardia • A-V refractory period • Atrial echoes • His bundle depolarization • A-V nodal tachycardia • A-V conduction • Reciprocal tachycardia • Atrial reentry

Submitted on July 29, 1970
Accepted on August 21, 1970

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