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Describes a rare electrophysiological mechanism where a double retrograde response over two dissociated pathways initiates and maintains an irregular supraventricular tachycardia.
Multiple supraventricular tachycardias were induced in a patient with two left posterior accessory pathways and dual atrioventricular nodal conduction. One of the accessory pathways conducts slowly and exhibits decremental conduction. A "double retrograde response" (2:1 ventriculoatrial conduction) due to simultaneous retrograde propagation of a single ventricular depolarization over two longitudinally dissociated pathways plays a role not only in tachycardia initiation, but in the maintenance of a unique, irregular tachycardia.
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Rosenfeld et al. (1990) studied this question.
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