Wolff‐Parkinson‐White SyndromeProblems in Evaluation of Multiple Accessory Pathways and Surgical Therapy
作者:
Philippe,
Coumel Marc,
Waynberger Alexandre,
Fabiato Robert,
Slama Jacques,
Aigueperse Yves,
期刊:
Circulation
(OVID Available online 1972)
卷期:
Volume 45,
issue 6
页码: 1216-1230
ISSN:0009-7322
年代: 1972
出版商: OVID
关键词: Kent bundle;James fibers;Retrograde conduction;Reciprocating tachycardia;His bundle division;Mahaim fibers;Antegrade conduction;His bundle electrograms;His bundle pacing;Preexcitation of left ventricle;Cancelled delta wave;Supernormal conduction in access
数据来源: OVID
摘要:
Total atrioventricular bypass (Kent bundle) does not explain all the findings in some cases of Wolff-Parkinson-White (W-P-W) syndrome. Two cases are reported in which two accessory pathways, set in series or in parallel, could be demonstrated. In case 1, a short P-R interval, gap phenomenon, and presence of delta wave with either a short or long P-R interval suggested the hypothesis of an atrio-His accessory path (James fibers). The presence of a type-B delta wave during His stimulation demonstrated the takeoff of another bypass (Mahaim fibers) below or at the point of stimulation. The His-ventricle accessory path had a supernormal phase of conduction during either atrial or His stimulation. In case 2, the rapid spread of the impulse to the His bundle (P-H 65 msec) was responsible for a normal H-R interval (35 msec) during either reciprocating tachycardia or normal sinus rhythm wtih a nonwidened QRS and minimal W-P-W deformity (partial cancellation of the delta wave). During reciprocating tachycardia, alternatively short and long P′-H intervals with constant H-R (His bundle) and R-P′ (Kent bundle) were due to alternate antegrade atrio-His conduction through the atrionodal nodal bypass (James fibers) and the A-V node. Surgical findings confirmed the existence of a left bundle of Kent. The division of the His bundle resulted in a maximal W-P-W deformity (type A) and abolished the reciprocating tachycardia.
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