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(Circulation. 1973;48:549.)
© 1973 American Heart Association, Inc.

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Demonstration of Dual A-V Nodal Pathways in Patients with Paroxysmal Supraventricular Tachycardia

PABLO DENES M.D.¹; DELON WU M.D.¹; RAMESH C. DHINGRA M.D.¹; RUBEN CHUQUIMIA M.D.¹; KENNETH M. ROSEN M.D.¹

¹ From the Cardiology Section, Abraham Lincoln School of Medicine, University of Illinois College of Medicine, West Side Veterans Administration Hospital, and Department of Adult Cardiology, Cook County Hospital, Chicago, Illinois.

Electrophysiological evidence suggestive of dual atrioventricular (A-V) nodal pathways is presented in two patients with normal P-R interval and reentrant paroxysmal supraventricular tachycardia (PSVT). His bundle recordings and atrial stimulation were used to obtain this electrophysiological evidence.

Refractory periods were measured with the atrial extra-stimulus technique. Plotting of H₁-H₂ responses against A₁-A₂ coupling intervals revealed that as A₁-A₂ decreased, H₁-H₂ decreased appropriately. At a critical A₁-A₂, a sudden marked increase in H₁-H₂ occurred, suggesting failure of fast pathway, (defining the fast pathway effective refractory period ERP). Further shortening of A₁-A₂ defined a second H₁-H₂ curve. The longest A₁-A₂ with no H₂ response was defined as the slow pathway ERP. Echo zones coincided with A₁-A₂ intervals equal to or less than the fast pathway ERP.

These results provide the first electrophysiological demonstration of dual A-V nodal pathways in patients with normal P-R interval and PSVT, as manifest by dual A-V nodal conduction times and refractory periods. Antegrade failure of the fast pathway with subsequent availability for retrograde conduction could allow A-V nodal reentry. These findings provide a basis for reentrance in some patients with reentrant PSVT.

Key Words: Paroxysmal atrial tachycardia • His bundle electrogram • Atrial echoes • A-V nodal reentry • A-V nodal bypass • Atrial pacing • A-V conduction • Wenckebach period • A-V refractory periods

Submitted on February 12, 1973
Accepted on April 24, 1973

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