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European Heart Journal 1984 5(3):233-242;
Copyright © 1984 by the European Society of Cardiology.
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© 1984 The European Society of Cardiology

Tachycardia caused by an accessory nodoventricular tract: a clinico-pathologic correlation

R. GMEINER*, CHOI KEUNG NG, I. HAMMER and A.E. BECKER

Departments of Internal Medicine, Surgery I and Pediatrics, University of Innsbruck, Austria and the Department of Pathology, Academic Medical Center, University of Amsterdam Amsterdam, The Netherlands

Received 26 May 1983; .

Address for correspondence: Anton E. Becker, M. D., Department of Pathology, H2-135, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, The Netherlands.

Abstract

Paroxysmal tachycardia with widened QRS complexes was recorded in an eleven-year old boy who had suffered from brain damage, which had resulted from an episode of ventricular fibrillation. Atrial stimulation produced an increased AV conduction, sudden disappearance of the His bundle deflection and a complete left bundle branch block pattern. Tachycardias of this morphology were initiated by early atrial and ventricular premature beats. The findings suggested the presence of a macro re-entry circuit, utilizing a slow A V node-nodoventricular bypass tract as the anterograde limb and the His-Purkinje system–fast A V node as the retrograde limb. This supposition found further support by serial sectioning of the A V junctional area of the heart, which revealed a nodoventricular tract, which originated from the posterior extension of the compact part of the atrioventricular node and inserted into the crest of the ventricular septum.

Key Words: tachycardia • re-entry • bypass test


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