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European Heart Journal 1988 9(3):295-300;
Copyright © 1988 by the European Society of Cardiology.
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© 1988 The European Society of Cardiology

Incidence of ‘dual A-V nodal pathways’ in first- and second-degree type I supra-His A-V block

M. DI BIASE, S. FAVALE, U. RIZZO, F. MINAFRA and P. RIZZON

Division of Cardiology, University of Bari Bari, Italy

address for correspondence: Dr Matteo Di Biase, Clinical Media I Cardiology, Policlinic, 70124

Abstract

The incidence of ‘dual A-V nodal pathways’, diagnosed on the basis of spontaneous or induced modifications in the PR interval, has been assessed in a group of168 consecutive patients with first- (77) and second-degree (91) type I supra-His block.‘ Dual A-V nodal pathways’ were found in 12 cases (16%) with first-degree and in 7 cases (7–7%) with second-degree type I supra-His A-V block. His bundle recording confirmed the hypothesis that PR interval variations observed in these cases are due to modifications in the AH interval and thus to changes in A-V nodal conduction velocity. The electrophysiologic study also showed that the phenomenon was easily reproduced by atrial stimulation. The frequent association between ‘dual A-V nodal pathways’ and supra-His blocks suggests that the block mechanism should be studied in depth as it could have prognostic and therapeutic implications.

Key Words: Dual A-V nodal • first-and-second-degree supra his- a-V block


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