Circulation, Vol 82, 407-417, Copyright © 1990 by American Heart Association
KH Kuck, KJ Friday, KP Kunze, M Schluter, R Lazzara and WM Jackman
Catheter recordings of accessory pathway (AP) activation were used to
identify the site of antegrade and retrograde AP conduction block in 126
consecutive patients undergoing electrophysiological testing. Activation
was recorded from 89 of 121 left free-wall and posteroseptal pathways (left
APs) and from 12 of 24 right free-wall, midseptal, and anteroseptal
pathways (right APs). The recorded APs were further subdivided into those
exhibiting consistent antegrade conduction during sinus rhythm (overt APs:
50 left APs, eight right APs), those exhibiting intermittent antegrade
conduction (intermittent APs: six left APs, two right APs), and those
exhibiting only retrograde conduction (concealed APs: 33 left APs, two
right APs). The sites of block were recorded during decremental atrial and
ventricular stimulation. The sites of both antegrade and retrograde block
were determined in 40 of 50 overt left APs and six of eight overt right
APs. Antegrade and retrograde block occurred at or near the AP-ventricular
(AP-V) interface in 37 of 40 overt left APs and two of six overt right APs
and at the atrial-AP (A-AP) interface in one of 40 overt left APs and four
of six overt right APs. In three of three overt left APs with no retrograde
conduction, retrograde block occurred at or near the AP-V interface. The
site of antegrade and retrograde block differed in only two of 58 overt
pathways. There was no difference between overt APs limited at the A-AP or
the AP-V interface in the shortest atrial or ventricular pacing cycle
length maintaining 1:1 antegrade or retrograde AP conduction, respectively.
Both antegrade and retrograde block occurred near the AP-V interface in
four of six intermittent left APs and zero of two intermittent right APs
and near the A-AP interface in two of six intermittent left APs and one of
two intermittent right APs. The sites of both antegrade and retrograde
block were determined in 28 of 33 concealed left APs, and both occurred at
or near the AP-V interface in 26 and A-AP interface in two APs. In two of
two concealed right APs, antegrade block occurred at the AP-V interface.
These findings suggest that both antegrade and retrograde conduction are
limited by factors operating near the AP-V interface in overt left APs and
at the A-AP or AP-V interface in overt right APs. Factors limiting
antegrade conduction in concealed APs appear to be located almost always
near the AP-V interface.
ARTICLES
Sites of conduction block in accessory atrioventricular pathways. Basis for concealed accessory pathways
Department of Cardiology, University Hospital Eppendorf, Hamburg, FRG.
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