Retrograde Supernormal Conduction, Gap Phenomenon in Concealed Accessory Atrioventricular Pathways

We present four patients with the Wolff‐Parkinson‐White syndrome who exhibited retrograde supernormal conduction or gap phenomenon in concealed accessory pathways. In the first patient, ventricular extrastimulus testing revealed retrograde block at the coupling interval of 520 msec and reappearance...

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Bibliographic Details
Published in:Pacing and clinical electrophysiology 1992-07, Vol.15 (7), p.1065-1079
Main Authors: SUZUKI, FUMIO, HARADA, TOMO-O, NAWATA, HIROKO, OHTOMO, KEN-ICHIRO, SATOH, TADASHI, HIRAO, KENZO, HIEJIMA, KAZUMASA
Format: Article
Language:English
Subjects:
Adult
Aged
atrioventricular simultaneous pacing
bradycardia-dependent block
Cardiac Pacing, Artificial - methods
concealed accessory atrioventricular pathway
Electrocardiography
Electrophysiology
Female
gap phenomenon
Heart Conduction System - physiopathology
Humans
Isoproterenol
Male
Middle Aged
retrograde supernormal conduction
Wolff-Parkinson-White Syndrome - diagnosis
Wolff-Parkinson-White Syndrome - physiopathology
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Summary:We present four patients with the Wolff‐Parkinson‐White syndrome who exhibited retrograde supernormal conduction or gap phenomenon in concealed accessory pathways. In the first patient, ventricular extrastimulus testing revealed retrograde block at the coupling interval of 520 msec and reappearance of conduction at the coupling interval of 370 msec. In a second patient, 1:1 retrograde conduction was not present but supernormal conduction was demonstrated at coupling intervals of 360 msec to 310 msec during the ventricular extrastimulus testing when the basic drive consisted of atrioventricular (AV) simultaneous pacing. In a third patient, ventricular extrastimulus testing demonstrated retrograde conduction through the accessory pathway only at coupling intervals of 400 msec to 360 msec. In a fourth patient, retrograde block occurred at the coupling interval of 340 msec and retrograde “slow” conduction reappeared at coupling intervals of 300 msec to 250 msec (gap phenomenon) only when the basic drive consisted of AV simultaneous pacing. Thus, concealed accessory pathways may exhibit retrograde supernormal conduction or gap phenomenon. Ventricular extrastimulus testing consisting of AV simultaneous pacing during the basic drive may facilitate demonstration of these unusual properties.
ISSN:0147-8389
1540-8159
DOI:10.1111/j.1540-8159.1992.tb03100.x