Bystander accessory pathway during AV node re-entrant tachycardia.

Journal Article (Journal Article)

Between 1970 and July 1980, wide QRS tachycardia due to re-entry confined to the AV node with bystander involvement of an accessory atrioventricular pathway (AAV) was documented in three of 290 patients with the Wolff-Parkinson-White syndrome studied at Duke Medical Center. In each of the patients, at least one transition between wide and narrow QRS morphology was recorded without change in either the cycle length of tachycardia or the atrial activation sequence. Two of the three patients had a single left-sided AAV (lateral, postero-lateral) showing antegrade conduction only. The third patient had two right-sided AAVs (free wall, septal), each capable of bidirectional conduction. Initiation and termination of repetitive concealed conduction into the ventricular insert of an AAV appeared to be one mechanism determining bystander AAV participation. Documentation of the retrograde sequence of atrial activation during tachycardia, and examination of the effects of interpolated premature depolarizations from both the ventricle and mid-line atrium are the most helpful features in resolving the differential diagnosis of wide QRS tachycardia in patients with W-P-W syndrome.

Full Text

Duke Authors

Cited Authors

  • Smith, WM; Broughton, A; Reiter, MJ; Benson, DW; Grant, AO; Gallagher, JJ

Published Date

  • May 1, 1983

Published In

Volume / Issue

  • 6 / 3 Pt 1

Start / End Page

  • 537 - 547

PubMed ID

  • 6191290

Pubmed Central ID

  • 6191290

International Standard Serial Number (ISSN)

  • 0147-8389

Digital Object Identifier (DOI)

  • 10.1111/j.1540-8159.1983.tb05293.x


  • eng

Conference Location

  • United States