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European Heart Journal 1988 9(9):991-996;
Copyright © 1988 by the European Society of Cardiology.
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© 1988 The European Society of Cardiology

Observations on variability of atrioventricular nodal conduction in man and the dual-pathway response

J. SANCHIS, V. LÓPEZ-MERINO, R. SANJUÁN, S. MORELL, F. J. CHORRO, R. GARCÍA-CIVERA and A. LLÁCER

Cardiology Service and Coronary Care Unit, Valencia University Clinic Hospital Valencia, Spain

Received 18 December 1987; revised 3 March 1988; .

Address for reprints: Dr Juan Sanchis-Forés. c/Grabador Manuel Peleguer. 2-5. 46022 Valencia, Spain

Abstract

A study was made of nodal conduction times of atrial stimuli with fixed coupling intervals, in 23 patients divided into two groups according to their atrial stimulus test response: Group I (continuous AV node function curve; 17 cases) and Gruop II (dual AV node pathway; six cases). The stimulation protocol involved the delivery of 75 stimuli with a fixed coupling interval 20 ms greater than the effective refractory period (ERP) of the AV node (Group I) or fast pathway (Group II). The atrial coupling intervals (A1A2) and node conduction times (A2H2) were measured. An evaluation was made of the dispersion of intervals with range (R) and of the distribution of A2H2 times ({chi}2 test).

In both Groups, R (A2H2) was greater than R(A1A2) (P<0.05): R(A2H2) in Group II was greater than R(A2H2) in Group I (P < 0.001). In Group I the distribution of A2H2 was non-normal in four cases and bimodal in five; in Group II the distribution was non-normal and bimodal in all cases.

It is concluded that: (1) the AV node generates a dispersion in its conduction times in the vicinity of its ERP, although the nodal conduction curve is continuous: and (2) the so-called dual pathway may constitute an exaggeration of AV node response inhomogeneity.

Key Words: AV note • atrioventricular conduction • dual AV nodal pathway


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