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European Heart Journal 1985 6(2):130-137;
Copyright © 1985 by the European Society of Cardiology.
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© 1985 The European Society of Cardiology

Electrophysiologic and histopathologic correlations in a case of permanent form of reciprocating tachycardia

G. CRITELLI, J. J. GALLAGHER*, G. THIENE{dagger}, F. PERTICONE, F. COLTORTI and L. ROSSI{ddagger}

Istituto di I Clinica Medica, II Facolta' di Medicina e Chirurgia dell ‘Universita’ di Napoli Italy
*The Sanger Clinic and Heineman Medical Research Center Charlotte, N. C. U.S.A.
{dagger}Istituto di Anatomia Patologica, Universita' di Padova Italy
{ddagger}Istituto di Anatomia Patologica, Universita' di Milano Italy

Received 13 September 1983; revised 20 November 1984; .

Address for reprints: Giuseppe Critelli, MD. Istituto di I Clinica Medica, ii Poiiciinico. via s. Pansini, 5. Napoli 80131. Italy.

Abstract

A case of permanent junctional reciprocating tachycardia with post-mortem documentation of an accessory atrioventricutar pathway as the substrate of the arrhythmia is reported. Tachycardia had lasted for 15 years and showed a retrograde P wave (P') and R–P' longer than P'–R interval. The tachycardia circuit utilized a concealed posterior septal accessory pathway as the retrograde limb. Because the arrhythmia was disabling and unresponsive to pharmacological treatment, the patient underwent closed chest ablation of the His bundle. After the procedure, no anterograde or retrograde conduction over the normal conduction system was observed; anterograde conduction over the anomalous pathway showed decremental properties. Because of previous myocardial infarction, the patient developed a ventricular aneurysm and died suddenly 5 months after His bundle ablation. Histological examination of the heart revealed a group of tiny fibromuscular bundles joining the lower rim of the coronary sinus outlet to the summit of the interventricular septums; the anomalous atrioventricular connection pursued a sinuous, tortuous path. The geometrical disposition of the accessory pathway may have been responsible for the decremental properties of conduction observed during life.

Key Words: Long RP tachycardia • refractory tachyarrhythmias • concealed preexcitation • His bundleablation


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