Demonstrates that the presence of dual AV nodal pathways can alter the presentation and cycle length of orthodromic circus movement tachycardia in patients with WPW syndrome.
Clinicians should consider dual AV nodal pathways in complex WPW tachycardias; case report leaves open prevalence and management implications.
In a patient with a left sided accessory pathway (AP) three different types of orthodromic circus movement tachycardia were observed: (1) narrow QRS complex tachycardia with a stable cycle length (CL); (2) wide QRS complex tachycardia with a functional bundle branch block ipsilateral to the AP, which, paradoxically, had a shorter CL. The decrease in CL was due to a decrease of the AH interval; and (3) narrow QRS complex tachycardia with alternating CL, due to alternations of the AH interval. These phenomena were attributed to a concomitant dual atrioventricular (AV) node, which was eventually proven after successful catheter ablation of the AP.
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Kreiner et al. (1993) studied this question.
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