Participation of a concealed nodoventricular fiber in the genesis of paroxysmal tachycardias

Delon Wu*, San Jou Yeh, Toshio Yamamoto, Fun Chung Lin, Nye Jan Cheng

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

21 Scopus citations


An unusual form of tachycardia circuit is described. The circuit incorporates a concealed nodoventricular fiber that conducts in a retrograde path, connects the atrioventricular node and the right ventricle, and also includes the distal portion of the atrioventricular node, the His-Purkinje system, and the ventricle. The study patient was first seen with paroxysmal tachycardias of normal QRS duration, complete right bundle branch block, and complete left bundle branch block. Electrophysiologic studies disclosed poor anterograde atrioventricular nodal conduction with a block proximal to His deflection that occurred at an atrial paced cycle length of 600 msec with no ventriculoatrial conduction. The tachycardias were inducible with two ventricular extrastimuli, had a His deflection that preceded each QRS complex and an HV interval identical to that during sinus rhythm, and revealed ventriculoatrial dissociation. Tachycardia with QRS patterns of right bundle branch block had a cycle 30 to 35 msec longer than tachycardias with either normal QRS duration or complete left bundle branch block. Tachycardias could be entrained by appropriate right ventricular pacing at rates slightly faster than the rate of tachycardia. Tachycardias could be terminated abruptly by an intravenous bolus of either adenosine triphosphate or verapamil.

Original languageEnglish
Pages (from-to)583-591
Number of pages9
JournalAmerican Heart Journal
Issue number3 PART 1
StatePublished - 03 1990
Externally publishedYes


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