Anatomic and electrophysiologic substrate of the permanent form of junctional reciprocating tachycardia

Data are reported on three patients with the permanent form of junctional reciprocating tachycardia, in whom conduction over a slow accessory pathway was observed after His bundle ablation. Tachycardia was almost incessant and showed a retrograde P wave (P') and RP' interval longer than P'R interval in all patients; during sinus rhythm, the PR interval was normal and there was no evidence of a delta wave. An accessory pathway with a long conduction time located in the posterior pyramidal space provided the retrograde limb of the reentry circuit. After His bundle ablation, the accessory pathway was capable of conducting in both anterograde and retrograde directions with decremental properties in all patients. Postmortem documentation of the accessory pathway was achieved in one patient. Serial sections revealed an accessory atrioventricular connection composed of ordinary myocardium joining the lower rim of the coronary sinus outlet to the uppermost ventricular muscle. This anomalous atrioventricular connection pursued a sinuous, tortuous path. As a result of changing cross-sectional area, such an accessory pathway might exhibit slow conduction, thus explaining its decremental characteristics.

This article has been cited by other articles:

				J.#x.;n. Farré, H. J.J. Wellens, J.#x. M. Rubio, and J. Benezet CHAPTER 28 Supraventricular Tachycardias ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]

				G Vaksmann, C D'Hoinne, V Lucet, S Guillaumont, J-M Lupoglazoff, A Chantepie, I Denjoy, E Villain, and F Marcon Permanent junctional reciprocating tachycardia in children: a multicentre study on clinical profile and outcome Heart, January 1, 2006; 92(1): 101 - 104. [Abstract] [Full Text] [PDF]

				J. Hluchy, S. Schickel, P. Schlegelmilch, U. Jorger, F. Bragelmann, and G.V. Sabin Decremental conduction properties in overt and concealed atrioventricular accessory pathways Europace, January 1, 2000; 2(1): 42 - 53. [Abstract] [PDF]

				E Jaeggi, J C Fouron, A Fournier, N van Doesburg, S P Drblik, and F Proulx Ventriculo-atrial time interval measured on M mode echocardiography: a determining element in diagnosis, treatment, and prognosis of fetal supraventricular tachycardia Heart, June 1, 1998; 79(6): 582 - 587. [Abstract] [Full Text]

				A. S. Manolis and N. A. M. Estes III Supraventricular Tachycardia: Mechanisms and Therapy Arch Intern Med, October 1, 1987; 147(10): 1706 - 1716. [Abstract] [PDF]