Clinical and electrophysiologic observations in patients with concealed accessory atrioventricular bypass tracts
Identifieur interne : 000098 ( Main/Corpus ); précédent : 000097; suivant : 000099Clinical and electrophysiologic observations in patients with concealed accessory atrioventricular bypass tracts
Auteurs : Ruey J. Sung ; Henry Gelband ; Agustin Castellanos ; Juan M. Aranda ; Robert J. MyerburgSource :
- The American Journal of Cardiology [ 0002-9149 ] ; 1977.
Abstract
In 12 of 46 consecutive patients with paroxysmal supraventricular tachycardia or atrial flutter-fibrillation, without electrocardiographic evidence of ventricular preexcitation, electrophysiologic studies suggested the presence of accessory atrioventricular (A-V) pathways capable only of retrograde conduction (concealed Wolff-Parkinson-White syndrome). The ages of these patients ranged from 29 days to 71 years (mean 39.2 years). Most patients were clinically symptomatic with palpitations, dizziness, weakness or congestive heart failure. One patient had “cardiac dysrhythmia” described by an obstetrician during intrauterine life. Eleven patients manifested A-V reciprocating tachycardia involving the normal pathway for anterograde conduction and the accessory pathway for retrograde conduction. The remaining patient manifested recurrent paroxysms of atrial flutter-fibrillation as a result of rapid ventriculoatrial activation through the accessory pathway during the atrial vulnerable phase.The electrophysiologic observations were analyzed with regard to clinical and electrocardiographic characteristics in these patients. The presence of concealed accessory pathways should be suspected in patients presenting with (1) an “incessant” form of tachycardia, (2) spontaneous onset of A-V reciprocal rhythms or reciprocating tachycardias after acceleration of the sinus rate without antecedent atrial extrasystoles or P-R interval prolongation, (3) slowing of the tachycardia rate consequent to the development of functional bundle branch block, (4) retrograde P waves (negative in leads II, III and aVF) discernible after the QRS complexes, with the R-P interval being shorter than the P-R interval during both A-V reciprocal rhythm and reciprocating tachycardia, and (5) oc-currence of atrial flutter-fibrillation in association with A-V reciprocal rhythms.It is suggested that medical treatment in patients having concealed accessory pathways should be aimed at increasing the refractoriness of either the A-V node or the accessory pathway for reciprocating tachycardia, while increasing the refractoriness of the atrium and the accessory pathway in cases with atrial flutter-fibrillation. Pacemaker therapy and surgical intervention may be indicated in selected patients refractory to antiarrhythmic agents.
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DOI: 10.1016/0002-9149(77)90032-7
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Clinical and electrophysiologic observations in patients with concealed accessory atrioventricular bypass tracts</title><author><name sortKey="Sung, Ruey J" sort="Sung, Ruey J" uniqKey="Sung R" first="Ruey J." last="Sung">Ruey J. Sung</name><affiliation><mods:affiliation>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</mods:affiliation></affiliation></author><author><name sortKey="Gelband, Henry" sort="Gelband, Henry" uniqKey="Gelband H" first="Henry" last="Gelband">Henry Gelband</name><affiliation><mods:affiliation>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</mods:affiliation></affiliation></author><author><name sortKey="Castellanos, Agustin" sort="Castellanos, Agustin" uniqKey="Castellanos A" first="Agustin" last="Castellanos">Agustin Castellanos</name><affiliation><mods:affiliation>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</mods:affiliation></affiliation></author><author><name sortKey="Aranda, Juan M" sort="Aranda, Juan M" uniqKey="Aranda J" first="Juan M." last="Aranda">Juan M. Aranda</name><affiliation><mods:affiliation>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</mods:affiliation></affiliation></author><author><name sortKey="Myerburg, Robert J" sort="Myerburg, Robert J" uniqKey="Myerburg R" first="Robert J." last="Myerburg">Robert J. Myerburg</name><affiliation><mods:affiliation>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:F0D3775A106BF64CA8F6D285C3D9F67802EC4194</idno><date when="1977" year="1977">1977</date><idno type="doi">10.1016/0002-9149(77)90032-7</idno><idno type="url">https://api.istex.fr/document/F0D3775A106BF64CA8F6D285C3D9F67802EC4194/fulltext/pdf</idno><idno type="wicri:Area/Main/Corpus">000098</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Clinical and electrophysiologic observations in patients with concealed accessory atrioventricular bypass tracts</title><author><name sortKey="Sung, Ruey J" sort="Sung, Ruey J" uniqKey="Sung R" first="Ruey J." last="Sung">Ruey J. Sung</name><affiliation><mods:affiliation>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</mods:affiliation></affiliation></author><author><name sortKey="Gelband, Henry" sort="Gelband, Henry" uniqKey="Gelband H" first="Henry" last="Gelband">Henry Gelband</name><affiliation><mods:affiliation>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</mods:affiliation></affiliation></author><author><name sortKey="Castellanos, Agustin" sort="Castellanos, Agustin" uniqKey="Castellanos A" first="Agustin" last="Castellanos">Agustin Castellanos</name><affiliation><mods:affiliation>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</mods:affiliation></affiliation></author><author><name sortKey="Aranda, Juan M" sort="Aranda, Juan M" uniqKey="Aranda J" first="Juan M." last="Aranda">Juan M. Aranda</name><affiliation><mods:affiliation>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</mods:affiliation></affiliation></author><author><name sortKey="Myerburg, Robert J" sort="Myerburg, Robert J" uniqKey="Myerburg R" first="Robert J." last="Myerburg">Robert J. Myerburg</name><affiliation><mods:affiliation>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">The American Journal of Cardiology</title><title level="j" type="abbrev">AJC</title><idno type="ISSN">0002-9149</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1977">1977</date><biblScope unit="volume">40</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="839">839</biblScope><biblScope unit="page" to="847">847</biblScope></imprint><idno type="ISSN">0002-9149</idno></series><idno type="istex">F0D3775A106BF64CA8F6D285C3D9F67802EC4194</idno><idno type="DOI">10.1016/0002-9149(77)90032-7</idno><idno type="PII">0002-9149(77)90032-7</idno><idno type="ArticleID">77900327</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0002-9149</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">In 12 of 46 consecutive patients with paroxysmal supraventricular tachycardia or atrial flutter-fibrillation, without electrocardiographic evidence of ventricular preexcitation, electrophysiologic studies suggested the presence of accessory atrioventricular (A-V) pathways capable only of retrograde conduction (concealed Wolff-Parkinson-White syndrome). The ages of these patients ranged from 29 days to 71 years (mean 39.2 years). Most patients were clinically symptomatic with palpitations, dizziness, weakness or congestive heart failure. One patient had “cardiac dysrhythmia” described by an obstetrician during intrauterine life. Eleven patients manifested A-V reciprocating tachycardia involving the normal pathway for anterograde conduction and the accessory pathway for retrograde conduction. The remaining patient manifested recurrent paroxysms of atrial flutter-fibrillation as a result of rapid ventriculoatrial activation through the accessory pathway during the atrial vulnerable phase.The electrophysiologic observations were analyzed with regard to clinical and electrocardiographic characteristics in these patients. The presence of concealed accessory pathways should be suspected in patients presenting with (1) an “incessant” form of tachycardia, (2) spontaneous onset of A-V reciprocal rhythms or reciprocating tachycardias after acceleration of the sinus rate without antecedent atrial extrasystoles or P-R interval prolongation, (3) slowing of the tachycardia rate consequent to the development of functional bundle branch block, (4) retrograde P waves (negative in leads II, III and aVF) discernible after the QRS complexes, with the R-P interval being shorter than the P-R interval during both A-V reciprocal rhythm and reciprocating tachycardia, and (5) oc-currence of atrial flutter-fibrillation in association with A-V reciprocal rhythms.It is suggested that medical treatment in patients having concealed accessory pathways should be aimed at increasing the refractoriness of either the A-V node or the accessory pathway for reciprocating tachycardia, while increasing the refractoriness of the atrium and the accessory pathway in cases with atrial flutter-fibrillation. Pacemaker therapy and surgical intervention may be indicated in selected patients refractory to antiarrhythmic agents.</div></front></TEI><istex><corpusName>elsevier</corpusName><author><json:item><name>Ruey J. Sung MD, FACC</name><affiliations><json:string>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</json:string></affiliations></json:item><json:item><name>Henry Gelband MD, FACC</name><affiliations><json:string>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</json:string></affiliations></json:item><json:item><name>Agustin Castellanos MD, FACC</name><affiliations><json:string>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</json:string></affiliations></json:item><json:item><name>Juan M. Aranda MD</name><affiliations><json:string>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</json:string></affiliations></json:item><json:item><name>Robert J. Myerburg MD, FACC</name><affiliations><json:string>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</json:string></affiliations></json:item></author><articleId><json:string>77900327</json:string></articleId><language><json:string>eng</json:string></language><abstract>In 12 of 46 consecutive patients with paroxysmal supraventricular tachycardia or atrial flutter-fibrillation, without electrocardiographic evidence of ventricular preexcitation, electrophysiologic studies suggested the presence of accessory atrioventricular (A-V) pathways capable only of retrograde conduction (concealed Wolff-Parkinson-White syndrome). The ages of these patients ranged from 29 days to 71 years (mean 39.2 years). Most patients were clinically symptomatic with palpitations, dizziness, weakness or congestive heart failure. One patient had “cardiac dysrhythmia” described by an obstetrician during intrauterine life. Eleven patients manifested A-V reciprocating tachycardia involving the normal pathway for anterograde conduction and the accessory pathway for retrograde conduction. The remaining patient manifested recurrent paroxysms of atrial flutter-fibrillation as a result of rapid ventriculoatrial activation through the accessory pathway during the atrial vulnerable phase.The electrophysiologic observations were analyzed with regard to clinical and electrocardiographic characteristics in these patients. The presence of concealed accessory pathways should be suspected in patients presenting with (1) an “incessant” form of tachycardia, (2) spontaneous onset of A-V reciprocal rhythms or reciprocating tachycardias after acceleration of the sinus rate without antecedent atrial extrasystoles or P-R interval prolongation, (3) slowing of the tachycardia rate consequent to the development of functional bundle branch block, (4) retrograde P waves (negative in leads II, III and aVF) discernible after the QRS complexes, with the R-P interval being shorter than the P-R interval during both A-V reciprocal rhythm and reciprocating tachycardia, and (5) oc-currence of atrial flutter-fibrillation in association with A-V reciprocal rhythms.It is suggested that medical treatment in patients having concealed accessory pathways should be aimed at increasing the refractoriness of either the A-V node or the accessory pathway for reciprocating tachycardia, while increasing the refractoriness of the atrium and the accessory pathway in cases with atrial flutter-fibrillation. Pacemaker therapy and surgical intervention may be indicated in selected patients refractory to antiarrhythmic agents.</abstract><qualityIndicators><score>7.816</score><pdfVersion>1.2</pdfVersion><pdfPageSize>612 x 828 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>0</keywordCount><abstractCharCount>2318</abstractCharCount><pdfWordCount>4816</pdfWordCount><pdfCharCount>36281</pdfCharCount><pdfPageCount>9</pdfPageCount><abstractWordCount>301</abstractWordCount></qualityIndicators><title>Clinical and electrophysiologic observations in patients with concealed accessory atrioventricular bypass tracts</title><pii><json:string>0002-9149(77)90032-7</json:string></pii><genre><json:string>research-article</json:string></genre><host><volume>40</volume><pii><json:string>S0002-9149(00)X0508-5</json:string></pii><pages><last>847</last><first>839</first></pages><issn><json:string>0002-9149</json:string></issn><issue>6</issue><genre><json:string>Journal</json:string></genre><language><json:string>unknown</json:string></language><title>The American Journal of Cardiology</title><publicationDate>1977</publicationDate></host><publicationDate>1977</publicationDate><copyrightDate>1977</copyrightDate><doi><json:string>10.1016/0002-9149(77)90032-7</json:string></doi><id>F0D3775A106BF64CA8F6D285C3D9F67802EC4194</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/F0D3775A106BF64CA8F6D285C3D9F67802EC4194/fulltext/pdf</uri></json:item><json:item><original>true</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/F0D3775A106BF64CA8F6D285C3D9F67802EC4194/fulltext/txt</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/F0D3775A106BF64CA8F6D285C3D9F67802EC4194/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/F0D3775A106BF64CA8F6D285C3D9F67802EC4194/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Clinical and electrophysiologic observations in patients with concealed accessory atrioventricular bypass tracts</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>ELSEVIER</p></availability><date>1977</date></publicationStmt><notesStmt><note type="content">Section title: Clinical study</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Clinical and electrophysiologic observations in patients with concealed accessory atrioventricular bypass tracts</title><author><persName><forename type="first">Ruey J.</forename><surname>Sung</surname></persName><roleName type="degree">MD, FACC</roleName><note type="biography">Address for reprints: Ruey J. Sung, MD, Division of Cardiology, Department of Medicine, University of Miami School of Medicine, P.O. Box 520875, Miami, Florida 33152.</note><affiliation>Address for reprints: Ruey J. Sung, MD, Division of Cardiology, Department of Medicine, University of Miami School of Medicine, P.O. Box 520875, Miami, Florida 33152.</affiliation><affiliation>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</affiliation></author><author><persName><forename type="first">Henry</forename><surname>Gelband</surname></persName><roleName type="degree">MD, FACC</roleName><affiliation>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</affiliation></author><author><persName><forename type="first">Agustin</forename><surname>Castellanos</surname></persName><roleName type="degree">MD, FACC</roleName><affiliation>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</affiliation></author><author><persName><forename type="first">Juan M.</forename><surname>Aranda</surname></persName><roleName type="degree">MD</roleName><affiliation>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</affiliation></author><author><persName><forename type="first">Robert J.</forename><surname>Myerburg</surname></persName><roleName type="degree">MD, FACC</roleName><affiliation>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</affiliation></author></analytic><monogr><title level="j">The American Journal of Cardiology</title><title level="j" type="abbrev">AJC</title><idno type="pISSN">0002-9149</idno><idno type="PII">S0002-9149(00)X0508-5</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1977"></date><biblScope unit="volume">40</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="839">839</biblScope><biblScope unit="page" to="847">847</biblScope></imprint></monogr><idno type="istex">F0D3775A106BF64CA8F6D285C3D9F67802EC4194</idno><idno type="DOI">10.1016/0002-9149(77)90032-7</idno><idno type="PII">0002-9149(77)90032-7</idno><idno type="ArticleID">77900327</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1977</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>In 12 of 46 consecutive patients with paroxysmal supraventricular tachycardia or atrial flutter-fibrillation, without electrocardiographic evidence of ventricular preexcitation, electrophysiologic studies suggested the presence of accessory atrioventricular (A-V) pathways capable only of retrograde conduction (concealed Wolff-Parkinson-White syndrome). The ages of these patients ranged from 29 days to 71 years (mean 39.2 years). Most patients were clinically symptomatic with palpitations, dizziness, weakness or congestive heart failure. One patient had “cardiac dysrhythmia” described by an obstetrician during intrauterine life. Eleven patients manifested A-V reciprocating tachycardia involving the normal pathway for anterograde conduction and the accessory pathway for retrograde conduction. The remaining patient manifested recurrent paroxysms of atrial flutter-fibrillation as a result of rapid ventriculoatrial activation through the accessory pathway during the atrial vulnerable phase.The electrophysiologic observations were analyzed with regard to clinical and electrocardiographic characteristics in these patients. The presence of concealed accessory pathways should be suspected in patients presenting with (1) an “incessant” form of tachycardia, (2) spontaneous onset of A-V reciprocal rhythms or reciprocating tachycardias after acceleration of the sinus rate without antecedent atrial extrasystoles or P-R interval prolongation, (3) slowing of the tachycardia rate consequent to the development of functional bundle branch block, (4) retrograde P waves (negative in leads II, III and aVF) discernible after the QRS complexes, with the R-P interval being shorter than the P-R interval during both A-V reciprocal rhythm and reciprocating tachycardia, and (5) oc-currence of atrial flutter-fibrillation in association with A-V reciprocal rhythms.It is suggested that medical treatment in patients having concealed accessory pathways should be aimed at increasing the refractoriness of either the A-V node or the accessory pathway for reciprocating tachycardia, while increasing the refractoriness of the atrium and the accessory pathway in cases with atrial flutter-fibrillation. Pacemaker therapy and surgical intervention may be indicated in selected patients refractory to antiarrhythmic agents.</p></abstract></profileDesc><revisionDesc><change when="1977-06-01">Registration</change><change when="1977-05-31">Modified</change><change when="1977">Published</change></revisionDesc></teiHeader></istex:fulltextTEI></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier, elements deleted: tail"><istex:xmlDeclaration>version="1.0" encoding="UTF-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 4.5.2//EN//XML" URI="art452.dtd" name="istex:docType"></istex:docType><istex:document><converted-article version="4.5.2" docsubtype="fla" xml:lang="en"><item-info><jid>AJC</jid><aid>77900327</aid><ce:pii>0002-9149(77)90032-7</ce:pii><ce:doi>10.1016/0002-9149(77)90032-7</ce:doi><ce:copyright type="unknown" year="1977"></ce:copyright></item-info><head><ce:dochead><ce:textfn>Clinical study</ce:textfn></ce:dochead><ce:title>Clinical and electrophysiologic observations in patients with concealed accessory atrioventricular bypass tracts</ce:title><ce:author-group><ce:author><ce:given-name>Ruey J.</ce:given-name><ce:surname>Sung</ce:surname><ce:degrees>MD, FACC</ce:degrees><ce:cross-ref refid="COR1"><ce:sup loc="post">∗</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Henry</ce:given-name><ce:surname>Gelband</ce:surname><ce:degrees>MD, FACC</ce:degrees></ce:author><ce:author><ce:given-name>Agustin</ce:given-name><ce:surname>Castellanos</ce:surname><ce:degrees>MD, FACC</ce:degrees></ce:author><ce:author><ce:given-name>Juan M.</ce:given-name><ce:surname>Aranda</ce:surname><ce:degrees>MD</ce:degrees></ce:author><ce:author><ce:given-name>Robert J.</ce:given-name><ce:surname>Myerburg</ce:surname><ce:degrees>MD, FACC</ce:degrees></ce:author><ce:affiliation><ce:textfn>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</ce:textfn></ce:affiliation><ce:correspondence id="COR1"><ce:label>∗</ce:label><ce:text>Address for reprints: Ruey J. Sung, MD, Division of Cardiology, Department of Medicine, University of Miami School of Medicine, P.O. Box 520875, Miami, Florida 33152.</ce:text></ce:correspondence></ce:author-group><ce:date-received day="21" month="3" year="1977"></ce:date-received><ce:date-revised day="31" month="5" year="1977"></ce:date-revised><ce:date-accepted day="1" month="6" year="1977"></ce:date-accepted><ce:abstract class="author"><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para view="all" id="simple-para.0010">In 12 of 46 consecutive patients with paroxysmal supraventricular tachycardia or atrial flutter-fibrillation, without electrocardiographic evidence of ventricular preexcitation, electrophysiologic studies suggested the presence of accessory atrioventricular (A-V) pathways capable only of retrograde conduction (concealed Wolff-Parkinson-White syndrome). The ages of these patients ranged from 29 days to 71 years (mean 39.2 years). Most patients were clinically symptomatic with palpitations, dizziness, weakness or congestive heart failure. One patient had “cardiac dysrhythmia” described by an obstetrician during intrauterine life. Eleven patients manifested A-V reciprocating tachycardia involving the normal pathway for anterograde conduction and the accessory pathway for retrograde conduction. The remaining patient manifested recurrent paroxysms of atrial flutter-fibrillation as a result of rapid ventriculoatrial activation through the accessory pathway during the atrial vulnerable phase.</ce:simple-para><ce:simple-para view="all" id="simple-para.0015">The electrophysiologic observations were analyzed with regard to clinical and electrocardiographic characteristics in these patients. The presence of concealed accessory pathways should be suspected in patients presenting with (1) an “incessant” form of tachycardia, (2) spontaneous onset of A-V reciprocal rhythms or reciprocating tachycardias after acceleration of the sinus rate without antecedent atrial extrasystoles or P-R interval prolongation, (3) slowing of the tachycardia rate consequent to the development of functional bundle branch block, (4) retrograde P waves (negative in leads II, III and aVF) discernible after the QRS complexes, with the R-P interval being shorter than the P-R interval during both A-V reciprocal rhythm and reciprocating tachycardia, and (5) oc-currence of atrial flutter-fibrillation in association with A-V reciprocal rhythms.</ce:simple-para><ce:simple-para view="all" id="simple-para.0020">It is suggested that medical treatment in patients having concealed accessory pathways should be aimed at increasing the refractoriness of either the A-V node or the accessory pathway for reciprocating tachycardia, while increasing the refractoriness of the atrium and the accessory pathway in cases with atrial flutter-fibrillation. Pacemaker therapy and surgical intervention may be indicated in selected patients refractory to antiarrhythmic agents.</ce:simple-para></ce:abstract-sec></ce:abstract></head></converted-article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Clinical and electrophysiologic observations in patients with concealed accessory atrioventricular bypass tracts</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Clinical and electrophysiologic observations in patients with concealed accessory atrioventricular bypass tracts</title></titleInfo><name type="personal"><namePart type="given">Ruey J.</namePart><namePart type="family">Sung</namePart><namePart type="termsOfAddress">MD, FACC</namePart><affiliation>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</affiliation><description>Address for reprints: Ruey J. Sung, MD, Division of Cardiology, Department of Medicine, University of Miami School of Medicine, P.O. Box 520875, Miami, Florida 33152.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Henry</namePart><namePart type="family">Gelband</namePart><namePart type="termsOfAddress">MD, FACC</namePart><affiliation>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Agustin</namePart><namePart type="family">Castellanos</namePart><namePart type="termsOfAddress">MD, FACC</namePart><affiliation>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Juan M.</namePart><namePart type="family">Aranda</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Robert J.</namePart><namePart type="family">Myerburg</namePart><namePart type="termsOfAddress">MD, FACC</namePart><affiliation>From the Division of Cardiology, Departments of Medicine and Pediatrics, Jackson Memorial Hospital and the Veterans Administration Hospital, University of Miami School of Medicine, Miami, Florida U.S.A.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">1977</dateIssued><dateValid encoding="w3cdtf">1977-06-01</dateValid><dateModified encoding="w3cdtf">1977-05-31</dateModified><copyrightDate encoding="w3cdtf">1977</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">In 12 of 46 consecutive patients with paroxysmal supraventricular tachycardia or atrial flutter-fibrillation, without electrocardiographic evidence of ventricular preexcitation, electrophysiologic studies suggested the presence of accessory atrioventricular (A-V) pathways capable only of retrograde conduction (concealed Wolff-Parkinson-White syndrome). The ages of these patients ranged from 29 days to 71 years (mean 39.2 years). Most patients were clinically symptomatic with palpitations, dizziness, weakness or congestive heart failure. One patient had “cardiac dysrhythmia” described by an obstetrician during intrauterine life. Eleven patients manifested A-V reciprocating tachycardia involving the normal pathway for anterograde conduction and the accessory pathway for retrograde conduction. The remaining patient manifested recurrent paroxysms of atrial flutter-fibrillation as a result of rapid ventriculoatrial activation through the accessory pathway during the atrial vulnerable phase.The electrophysiologic observations were analyzed with regard to clinical and electrocardiographic characteristics in these patients. The presence of concealed accessory pathways should be suspected in patients presenting with (1) an “incessant” form of tachycardia, (2) spontaneous onset of A-V reciprocal rhythms or reciprocating tachycardias after acceleration of the sinus rate without antecedent atrial extrasystoles or P-R interval prolongation, (3) slowing of the tachycardia rate consequent to the development of functional bundle branch block, (4) retrograde P waves (negative in leads II, III and aVF) discernible after the QRS complexes, with the R-P interval being shorter than the P-R interval during both A-V reciprocal rhythm and reciprocating tachycardia, and (5) oc-currence of atrial flutter-fibrillation in association with A-V reciprocal rhythms.It is suggested that medical treatment in patients having concealed accessory pathways should be aimed at increasing the refractoriness of either the A-V node or the accessory pathway for reciprocating tachycardia, while increasing the refractoriness of the atrium and the accessory pathway in cases with atrial flutter-fibrillation. Pacemaker therapy and surgical intervention may be indicated in selected patients refractory to antiarrhythmic agents.</abstract><note type="content">Section title: Clinical study</note><relatedItem type="host"><titleInfo><title>The American Journal of Cardiology</title></titleInfo><titleInfo type="abbreviated"><title>AJC</title></titleInfo><genre type="Journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">197712</dateIssued></originInfo><identifier type="ISSN">0002-9149</identifier><identifier type="PII">S0002-9149(00)X0508-5</identifier><part><date>197712</date><detail type="volume"><number>40</number><caption>vol.</caption></detail><detail type="issue"><number>6</number><caption>no.</caption></detail><extent unit="issue pages"><start>A3</start><end>A47</end></extent><extent unit="issue pages"><start>A51</start><end>A63</end></extent><extent unit="issue pages"><start>A70</start><end>A72</end></extent><extent unit="issue pages"><start>A81</start><end>A88</end></extent><extent unit="issue pages"><start>A95</start><end>A111</end></extent><extent unit="issue pages"><start>839</start><end>1032</end></extent><extent unit="pages"><start>839</start><end>847</end></extent></part></relatedItem><identifier type="istex">F0D3775A106BF64CA8F6D285C3D9F67802EC4194</identifier><identifier type="DOI">10.1016/0002-9149(77)90032-7</identifier><identifier type="PII">0002-9149(77)90032-7</identifier><identifier type="ArticleID">77900327</identifier><recordInfo><recordContentSource>ELSEVIER</recordContentSource></recordInfo></mods></metadata><enrichments><istex:refBibTEI uri="https://api.istex.fr/document/F0D3775A106BF64CA8F6D285C3D9F67802EC4194/enrichments/refBib"><teiHeader></teiHeader><text><front></front><body></body><back><listBibl><biblStruct><analytic><title level="a" type="main">Reciprocating tachycardia in overt and latent cainamide and quinidine sulfate in the Wolff-Parkinson-White preexcitation. Influence of functional bundle branch block on the syndrome rate of the tachycardia</title><author><persName><forename type="first">Coumel</forename><forename type="middle">P</forename></persName></author></analytic><monogr><title level="j">Circulation Eur J Cardiol</title><imprint><biblScope unit="volume">55</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="15" to="22423"></biblScope><date type="published" when="1974"></date></imprint></monogr></biblStruct><biblStruct><monogr><author><persName><surname>Gallagher</surname></persName></author><author><persName><forename type="first">Gilbert</forename><forename type="middle">M</forename><surname>Jj</surname></persName></author><author><persName><surname>Svenson Rh</surname></persName></author><imprint><publisher>Wolff-Parkinson-White</publisher></imprint></monogr></biblStruct><biblStruct><monogr><title level="m" type="main">Concealed bypasses of the syndrome. The problem, evaluation, and surgical correction. Cir-atrioventricular node in patients with paroxysmal supraventricular culation</title><author><persName><surname>Spurrel Ra</surname></persName></author><author><persName><surname>Krikler Dm</surname></persName></author><author><persName><surname>Sowton</surname></persName></author><imprint><date type="published" when="1975"></date><biblScope unit="page" from="767" to="785"></biblScope></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Electrophysiological verapamil</title><author><persName><surname>Svenson Rh</surname></persName></author><author><persName><surname>Miller</surname></persName></author><author><persName><surname>Hc</surname></persName></author><author><persName><surname>Gallagher</surname></persName></author><author><persName><surname>Jj</surname></persName></author></analytic><monogr><title level="j">Am J Cardiol</title><imprint><publisher>Parkinson-White syndrome</publisher><publisher>Parkinson-White syndrome</publisher><biblScope unit="page" from="33590" to="595"></biblScope><date type="published" when="1974"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Unusual properties of assessing antegrade and retrograde conduction over the accessory accessory pathways</title><author><persName><forename type="first">Zlpes</forename><forename type="middle">Dp</forename><surname>Dejoseph Rl</surname></persName></author><author><persName><surname>Da</surname></persName></author></analytic><monogr><title level="j">Circulation Circulation</title><imprint><biblScope unit="volume">49</biblScope><biblScope unit="issue">52</biblScope><biblScope unit="page" from="1200" to="1211552"></biblScope><date type="published" when="1974"></date></imprint></monogr></biblStruct><biblStruct><monogr><title level="m" type="main">Narula OS: Retrograde pre-excitation. Comparison of antegrade</title></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Patterns of ventriculo-atrial conduction and retrograde conduction intervals in man Circulation 50: in the Wolff-Parkinson-White syndrome</title><author><persName><forename type="first">Wellens</forename><forename type="middle">Hjj</forename><surname>Durrer</surname></persName></author></analytic><monogr><title level="j">Circulation</title><imprint><biblScope unit="volume">49</biblScope><biblScope unit="page" from="22" to="31"></biblScope><date type="published" when="19741974"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Analysis of re-entry mech-anisms in three patients with concealed Wolff-Parkinson-White syndrome</title><author><persName><forename type="first">Neuss</forename><forename type="middle">H M</forename><surname>Schlepper</surname></persName></author><author><persName><surname>Thormann</surname></persName></author></analytic><monogr><title level="j">Circulation</title><imprint><biblScope unit="volume">51</biblScope><biblScope unit="page" from="75" to="61"></biblScope><date type="published" when="1975"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">The role of an accessory atrioventricular pathway in reciprocal tachycardia. Observations in patients with and without the Wolff-Parkinson-White syndrome</title><author><persName><forename type="first">Wellens</forename><forename type="middle">Hjj</forename><surname>Durrer</surname></persName></author></analytic><monogr><title level="j">Circulation</title><imprint><biblScope unit="volume">52</biblScope><biblScope unit="page" from="56" to="72"></biblScope><date type="published" when="1975"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Antegrade block in accessory pathways with retrograde conduction in reciprocating tachycardia</title><author><persName><surname>Tonkin</surname></persName></author><author><persName><surname>Am</surname></persName></author><author><persName><forename type="middle">Jj</forename><surname>Gallagher</surname></persName></author><author><persName><surname>Svenson Rh</surname></persName></author></analytic><monogr><title level="j">Eur J Cardiol</title><imprint><biblScope unit="volume">3</biblScope><biblScope unit="page" from="143" to="152"></biblScope><date type="published" when="1975"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Intractable paroxysmal tachycardia caused by a concealed retrogradely conducting Kent bundle. Demonstration by epicardial mapping and cure of tachy-cardias by surgical interruption of the His bundle</title><author><persName><forename type="first">Denes</forename><forename type="middle">P</forename></persName></author><author><persName><forename type="first">Wyndham</forename><forename type="middle">Crc</forename><surname>Rosen</surname></persName></author></analytic><monogr><title level="j">Br Heart J</title><imprint><biblScope unit="volume">38</biblScope><biblScope unit="page" from="758" to="763"></biblScope><date type="published" when="1976"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Junctional reciprocating tachycardias. The permanent and paroxysmal forms of A-V nodal reciprocating tachycardias</title><author><persName><surname>Coumel</surname></persName></author></analytic><monogr><title level="j">J Electrocardiol</title><imprint><biblScope unit="volume">8</biblScope><biblScope unit="page" from="79" to="90"></biblScope><date type="published" when="1975"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Incessant " tachycardias in Wolff-Parkinson-White syndrome. I. Initiation without antecedent extrasystoles or PR lengthening, with reference to reciprocation after shortening of cycle length</title><author><persName><forename type="middle">D</forename><surname>Krikler</surname></persName></author><author><persName><forename type="middle">P</forename><surname>Curry</surname></persName></author><author><persName><forename type="middle">P</forename><surname>Attuel</surname></persName></author></analytic><monogr><title level="j">Br Heart J</title><imprint><biblScope unit="volume">38</biblScope><biblScope unit="page" from="885" to="896"></biblScope><date type="published" when="1976"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Klstin AD: Atrial reciprocal rhythm</title></analytic><monogr><title level="j">Circulation</title><imprint><biblScope unit="volume">32</biblScope><biblScope unit="page" from="687" to="707"></biblScope><date type="published" when="1965"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Atrial reciprocal rhythm and reciprocating tachycardia in Wolff-Parkinson-White syndrome</title><author><persName><forename type="first">Roelandt</forename><forename type="middle">J</forename><surname>Van</surname></persName></author><author><persName><surname>Hauwaert</surname></persName></author></analytic><monogr><title level="j">Circulation</title><imprint><biblScope unit="volume">38</biblScope><biblScope unit="page" from="64" to="72"></biblScope><date type="published" when="1968"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Mechanism of recip-rocating tachycardia initiated during sinus rhythm in concealed Wolff-Parkinson-White syndrome</title><author><persName><forename type="first">Castellanos</forename><forename type="middle">Rj A</forename><surname>Sung</surname></persName></author><author><persName><forename type="middle">H</forename><surname>Gelband</surname></persName></author></analytic><monogr><title level="j">Circulation</title><imprint><biblScope unit="volume">54</biblScope><biblScope unit="page" from="338" to="344"></biblScope><date type="published" when="1976"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Catheter mapping of retrograde atrial activation. Observations during ventricular pacing and A-V nodal re-entrant paroxysmal tachycardia</title><author><persName><forename type="first">-Y-Leon</forename><forename type="middle">F</forename><surname>Amat</surname></persName></author><author><persName><forename type="middle">Rc</forename><surname>Dhingra</surname></persName></author><author><persName><forename type="middle">D</forename><surname>Wu</surname></persName></author></analytic><monogr><title level="j">Br Heart J</title><imprint><biblScope unit="volume">38</biblScope><biblScope unit="page" from="355" to="362"></biblScope><date type="published" when="1976"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">A-V reciprocal rhythm and chronic reciprocating tachycardia in a newborn infant with con-cealed Wolff-Parkinson-White syndrome</title><author><persName><forename type="middle">Rj</forename><surname>Sung</surname></persName></author><author><persName><forename type="middle">P</forename><surname>Ferrer</surname></persName></author><author><persName><surname>Garcia</surname></persName></author><author><persName><surname>Ol</surname></persName></author></analytic><monogr><title level="j">Br Heart J</title><imprint><biblScope unit="volume">39</biblScope><biblScope unit="page" from="810" to="814"></biblScope><date type="published" when="1977"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Bipolar catheter electrograms for study of retrograde atrial activation pattern in patients without pm-excitation syndromes</title><author><persName><surname>Agha As</surname></persName></author><author><persName><forename type="first">Castellanos</forename><forename type="middle">B</forename><surname>Befeler</surname></persName></author><author><persName><surname>Am</surname></persName></author></analytic><monogr><title level="j">Br Heart J</title><imprint><biblScope unit="volume">38</biblScope><biblScope unit="page" from="641" to="645"></biblScope><date type="published" when="1976"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Wolff-Parkinson-White syndrome in infants and children. A long-term follow-up study</title><author><persName><forename type="first">Ehlers</forename><forename type="middle">Kh</forename><surname>Giardlna Acv</surname></persName></author><author><persName><surname>Engle</surname></persName></author><author><persName><surname>Ma</surname></persName></author></analytic><monogr><title level="j">Br Heart J</title><imprint><biblScope unit="volume">34</biblScope><biblScope unit="page" from="839" to="846"></biblScope><date type="published" when="1972"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Reciprocating tachycardia caused by accessory pathways in the absence of ventricular pre-excitation (abstr)</title><author><persName><surname>Pritchett</surname></persName></author><author><persName><surname>Elc</surname></persName></author><author><persName><forename type="middle">Jj</forename><surname>Gallagher</surname></persName></author><author><persName><surname>Sealy</surname></persName></author><author><persName><surname>Wc</surname></persName></author></analytic><monogr><title level="j">Circulation</title><imprint><biblScope unit="volume">5354</biblScope><biblScope unit="page">188</biblScope><date type="published" when="1976"></date></imprint></monogr><note>Suppl. ll</note></biblStruct><biblStruct><monogr><title level="m" type="main">Pre-excitation syndrome. In, The Atrioven-tricular Node and Selected Cardiac Arrhythmias</title><author><persName><forename type="middle">D</forename><surname>Scherf</surname></persName></author><author><persName><forename type="middle">J</forename><surname>Cohen</surname></persName></author><imprint><date type="published" when="1964"></date><biblScope unit="page" from="372" to="447"></biblScope><pubPlace>New York, Grune & Stratton</pubPlace></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Electrophysiological studies with multiple drugs in patients with reentrant tachycardias due to con-cealed extranodal pathways (abstr)</title><author><persName><forename type="first">Denes</forename><forename type="middle">D P</forename><surname>Wu</surname></persName></author><author><persName><forename type="middle">R</forename><surname>Miller</surname></persName></author></analytic><monogr><title level="j">Circulation</title><imprint><biblScope unit="volume">53</biblScope><biblScope unit="issue">54</biblScope><biblScope unit="page" from="11" to="188"></biblScope><date type="published" when="1976"></date></imprint></monogr><note>Suppl. II</note></biblStruct><biblStruct><analytic><title level="a" type="main">Catheter technique for recording His bundle activity in man</title><author><persName><forename type="middle">Bj</forename><surname>Scherlag</surname></persName></author><author><persName><surname>Lau</surname></persName></author><author><persName><surname>Sh</surname></persName></author><author><persName><surname>Helfant Rh</surname></persName></author></analytic><monogr><title level="j">Circulation</title><imprint><biblScope unit="volume">39</biblScope><biblScope unit="page" from="13" to="18"></biblScope><date type="published" when="1969"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Patterns of atrioventricular conduction in the human heart</title><author><persName><forename type="first">Wi</forename><surname>Al</surname></persName></author><author><persName><forename type="first">Weiss</forename><forename type="middle">Mb</forename><surname>Berkowitz</surname></persName></author><author><persName><surname>Wd</surname></persName></author></analytic><monogr><title level="j">Circ Res</title><imprint><biblScope unit="volume">27</biblScope><biblScope unit="page" from="345" to="359"></biblScope><date type="published" when="1970"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Mode of initiation of reciprocating tachycardia during programmed ventricular stimu-lation in the Wolff-Parkinson-White syndrome. With reference to various patterns of ventriculoatrial conduction</title><author><persName><forename type="first">Castellanos</forename><forename type="middle">Rj A</forename><surname>Sung</surname></persName></author><author><persName><surname>Mallon</surname></persName></author><author><persName><surname>Sm</surname></persName></author></analytic><monogr><title level="j">Am J Cardiol</title><imprint><biblScope unit="volume">40</biblScope><biblScope unit="page" from="24" to="31"></biblScope><date type="published" when="1977"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">The electrophysiological properties of the accessory pathway in the Wolff-Parkinson-White syndrome</title><author><persName><surname>Wellens</surname></persName></author><author><persName><surname>Hjj</surname></persName></author></analytic><monogr><title level="m">Conduction System of the Heart</title><meeting><address>Wellens HJJ, Lie KI, Janse MJ ; Leiden, Stenfert Kroese</address></meeting><imprint><date type="published" when="1976"></date><biblScope unit="page" from="567" to="587"></biblScope></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">The effects of cyle length on cardiac refractory periods in man</title><author><persName><forename type="first">Denes</forename><forename type="middle">P D</forename><surname>Wu</surname></persName></author><author><persName><forename type="middle">R</forename><surname>Dhingra</surname></persName></author></analytic><monogr><title level="j">Circulation</title><imprint><biblScope unit="volume">49</biblScope><biblScope unit="page" from="32" to="41"></biblScope><date type="published" when="1974"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Refractory periods of the accessory pathway in the Wolff-Parkinson-White syndrome</title><author><persName><surname>Tonkln Am</surname></persName></author><author><persName><surname>Miller Hc</surname></persName></author><author><persName><surname>Svenson Rh</surname></persName></author></analytic><monogr><title level="j">Circulation</title><imprint><biblScope unit="volume">52</biblScope><biblScope unit="page" from="563" to="569"></biblScope><date type="published" when="1975"></date></imprint></monogr></biblStruct><biblStruct><monogr><title level="m" type="main">Mechanisms of spon-taneous conversion between reciprocating tachycardia and atria1 flutter-fibrillation in the Wolff-Parkinson-White syndrome (abstr)</title><author><persName><forename type="first">Castellanos</forename><forename type="middle">Rj A</forename><surname>Sung</surname></persName></author><author><persName><surname>Mallon</surname></persName></author><author><persName><surname>Sm</surname></persName></author></monogr></biblStruct><biblStruct><analytic></analytic><monogr><title level="j">Am J Cardiol</title><imprint><biblScope unit="volume">39</biblScope><biblScope unit="page">319</biblScope><date type="published" when="1977"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Ventriculo-atrial conduction time during reciprocating tachycardia with intermittent bundle-branch block in Wolff-Parkinson-White syndrome</title><author><persName><surname>Pritchett Elc</surname></persName></author><author><persName><surname>Tonkln</surname></persName></author><author><persName><surname>Am</surname></persName></author><author><persName><surname>Dugan</surname></persName></author><author><persName><surname>Fa</surname></persName></author></analytic><monogr><title level="j">Br Heart J</title><imprint><biblScope unit="volume">38</biblScope><biblScope unit="page" from="1058" to="1064"></biblScope><date type="published" when="1976"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Demonstration of dual A-V nodal pathways in patients with paroxysmal supraventricular tachycardia</title><author><persName><forename type="first">Denes</forename><forename type="middle">P D</forename><surname>Wu</surname></persName></author><author><persName><surname>Dhingra Rc</surname></persName></author></analytic><monogr><title level="j">Circulation</title><imprint><biblScope unit="volume">48</biblScope><biblScope unit="page" from="549" to="555"></biblScope><date type="published" when="1973"></date></imprint></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Wolff-Parkinson-White syndrome and atrial fibrillation. Relation between refractory period of accessory pathway and ventricular rate during atrial fibrillation</title><author><persName><forename type="first">Wellens</forename><forename type="middle">Hjj</forename><surname>Durrer</surname></persName></author></analytic><monogr><title level="j">Am J Cardiol</title><imprint><biblScope unit="volume">34</biblScope><biblScope unit="page" from="771" to="782"></biblScope><date type="published" when="1974"></date></imprint></monogr></biblStruct><biblStruct><monogr><author><persName><surname>Sellers</surname></persName></author><author><persName><surname>Jr</surname></persName></author><author><persName><surname>Campbell Rwf</surname></persName></author><author><persName><surname>Bashore</surname></persName></author><author><persName><surname>Tm</surname></persName></author></monogr></biblStruct><biblStruct><analytic><title level="a" type="main">Clinical, electrocardio-graphic, and electrophysiological observations in patients with paroxysmal supraventricular tachycardia (abstr)</title><author><persName><forename type="first">Denes</forename><forename type="middle">D P</forename><surname>Wu</surname></persName></author><author><persName><forename type="middle">F</forename><surname>Leon</surname></persName></author></analytic><monogr><title level="j">Am J Cardiol</title><imprint><biblScope unit="volume">39</biblScope><biblScope unit="page">264</biblScope><date type="published" when="1977"></date></imprint></monogr></biblStruct><biblStruct><monogr><title level="m" type="main">An unusual variety of A-V nodal reentry due to retrograde dual A-V nodal pathways (abstr)</title><author><persName><forename type="first">Denes</forename><forename type="middle">D P</forename><surname>Wu</surname></persName></author><author><persName><forename type="middle">F</forename><surname>Leon</surname></persName></author></monogr></biblStruct><biblStruct><analytic></analytic><monogr><title level="j">Clin Res The American Journal of CARDIOLOGY</title><imprint><biblScope unit="volume">25</biblScope><biblScope unit="issue">40</biblScope><biblScope unit="page">262</biblScope><date type="published" when="1977-12"></date></imprint></monogr></biblStruct></listBibl></back></text></istex:refBibTEI></enrichments><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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