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Slow-fast Form of Atrioventricular Nodal Reentrant Tachycardia with Unusual Retrograde Activation in the Right Atrium —Possible Conduction Disturbance across the Tendon of Todaro Related to the Genesis of Positive Component of Biphasic Retrograde P Wave—

Authors :
Kazuya Ishibashi, MD
Satoshi Hirasaki, MD
Ryohei Matsuo, MD
Masaki Tsukamoto, MD
Koichi Kawata, MD
Fumio Suzuki, MD
Source :
Journal of Arrhythmia, Vol 22, Iss 1, Pp 52-57 (2006)
Publication Year :
2006
Publisher :
Wiley, 2006.

Abstract

We report a rare case of slow-fast form of atrioventricular nodal reentrant tachycardia with delayed activation in the low septal right atrium (His bundle area). During supraventricular tachycardia (SVT), electrocardiogram showed “pseudo-positive P waves” in II, III, and aVF leads. SVT was induced by atrial extrastimulus with marked AH prolongation (i.e., jump phenomenon). Ventricular pacing showed a decremental retrograde conduction without jump phenomenon. Double atrial potentials were observed in the His bundle area during SVT and during ventricular pacing. The first electrogram of these split potentials, which was the earliest activation during SVT and during ventricular pacing, showed a dull and small deflection, whereas the second electrogram was sharp and clear. The interval of these discrete potentials was 70 msec during SVT. After a standard slow pathway ablation, SVT could never be induced by any programmed stimuli. It was concluded that in this case, the conduction disturbance across the tendon of Todaro was likely to cause the delayed atrial activation in the His bundle area, which created the pseudo-positive (biphasic. retrograde P wave.

Details

Language :
English
ISSN :
18804276
Volume :
22
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Journal of Arrhythmia
Publication Type :
Academic Journal
Accession number :
edsdoj.6caea3518c1e4c3c9af2cb7b6a349377
Document Type :
article
Full Text :
https://doi.org/10.1016/S1880-4276(06)80008-6