Role of His-Purkinje System in the Initiation of Orthodromic Tachycardia in Wolff-Parkinson-White Syndrome
With the introduction of intracardiac recording techniques and programmed electrical stimulation, the tachyarrhythmias in Wolff-ParkinsonWhite (WPW) have been extensively studied [1–10]. The most common arrhythmia in this patient population is the reciprocating tachycardia utilizing the normal pathway in one direction and the accessory pathway in the other. Less commonly, the accessory pathway may constitute both the anterograde and retrograde limbs of the reentry circuit [8,10]. Depending upon the site and method of stimulation, presence of multiple accessory pathways, as well as the electrophysiologic properties of the accessory and normal pathways in both directions, reciprocating tachycardia of either the orthodromic or antidromic variety can be initiated. With the usual pacing techniques (incremental and extrastimulus method) from the atrial and ventricular sites the orthodromic reciprocating tachycardia is induced more frequently and consistently than the antidromic type . Since orthodromic reciprocating tachycardia is also the more common clinical arrhythmia and its electrophysiology is more clearly understood, it will be the primary subject of this review .
KeywordsCycle Length Left Bundle Branch Block Ventricular Pace Accessory Pathway Effective Refractory Period
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