Spontaneous termination of circus movement tachycardia using an atrioventricular accessory pathway: incidence, site of block and mechanisms.

The incidence, mechanisms and sites of block of spontaneous termination of circus movement tachycardia (CMT) using an atrioventricular accessory pathway (AP) were analyzed in 24 consecutive patients (17 with Wolff-Parkinson-White syndrome and seven with a concealed AP) who were not receiving antiarrhythmic drugs. Spontaneous termination of tachycardia occurred in 10 patients (105 episodes). A reduced "safety margin" of tachycardia was the only factor that was significantly more common in the patients who manifested spontaneous termination (p less than 0.01). The site of spontaneous block was located in the AP in six patients (50 episodes), atrioventricular node (AVN) in six patients (37 episodes) and His-Purkinje system (HPS) in three patients (18 episodes). At least 14 mechanisms leading to block in the tachycardia circuit were identified. Labile conduction during tachycardia occurred at multiple sites (AVN, His bundle, bundle branches, and AP). Analysis of the duration of tachycardia before spontaneous termination showed a characteristic time pattern for block at each site, consistent with the autonomic and electrophysiologic changes that occur after induction of tachycardia. Spontaneous termination of CMT using an AP is a common phenomenon. Many mechanisms are involved, which are often complex and dependent on interplay of the electrophysiologic characteristics of the components of the tachycardia circuit.