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• W2913413732 abstract "To the Editor: We read with great interest the article by Lozano et al, entitled “Reentrant Tachycardia: Participation of the Distal A-V Conduction System.”1Lozano J Mandel WJ Hayakawa H et al.Reentrant tachycardia: Participation of the distal A-V conducting system.Chest. 1973; 63: 23Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Intraventricular reentry as a mechanism for atrial echo beats and perhaps sustained supraventricular tachycardia has recently been described in our laboratory.2Varghese PJ Damato AN Caracta AR et al.Intraventricular reentry: A mechanism for atrial echo beats.Am J Cardiol. 1973; 31: 163Abstract Full Text PDF Google Scholar The criteria for such a mechanism include: 1) at a constant A-V nodal conduction delay, atrial echo beats occur only at a critical intraventricular conduction delay (ie, long H-V interval); 2) with variable intraventricular conduction delay produced by changing preceding cycle length, atrial echoes still only occurred with a critical prolongation of the H-V interval; 3) at variable degrees of A-V nodal conduction delay, the atrial echo is dependent only on prolongation of the H-V interval; and 4) at a constant A-V nodal conduction delay, the interval between ventricular depolarization and the atrial echo has a reciprocal relationship to the H-V interval. The case presented by Lozano et al fulfills none of the above criteria. Although the patient's tachycardia (Fig 4A—Lozano et al) resulted from an echo following a premature beat with an H2-V2 of 80 msec, the A2-H2 was 131 msec, this being the greatest amount of A-V nodal delay seen.2Varghese PJ Damato AN Caracta AR et al.Intraventricular reentry: A mechanism for atrial echo beats.Am J Cardiol. 1973; 31: 163Abstract Full Text PDF Google Scholar Therefore, one cannot state that it was the intraventricular conduction delay and not A-V nodal delay that was critical.3Goldreyer BN Damato AN The essential role of atrioventricular conduction delay in the initiation of paroxysmal supraventricular tachycardia.Circulation. 1971; 43: 679Crossref PubMed Scopus (152) Google Scholar, 4Goldreyer BN Bigger Jr, JT Spontaneous and induced reentrant tachycardia.Ann Inter Med. 1969; 70: 87Crossref PubMed Scopus (51) Google Scholar, 5Goldreyer BN Weiss MB Damato AN Supraventricular tachycardia initiated by sinus beats.Circulation. 1971; 44: 820Crossref PubMed Scopus (15) Google Scholar, 6Bigger Jr, JT Goldreyer BN The mechanism of supraventricular tachycardia.Circulation. 1970; 42: 673Crossref PubMed Scopus (157) Google Scholar More important than this is the fact that the “atrial echo” appears to have a high atrial to low atrial sequence especially when compared to the ventricular electrogram in Figure 3B (Lozano et al). Such a sequence indicates that sinus node reentry or intraatrial reentry is the mechanism of this atrial echo.7Wallace AG Daggett WM Re-exdtation of the atrium. The Echo Phenomen.Am Heart J. 1964; 68: 661Abstract Full Text PDF PubMed Scopus (35) Google Scholar, 8Paulay KL Varghese PJ Damato AN Sinus node reentry: An in vitro demonstration in the dog.Circulation. 1972; 46: 27Google Scholar, 9Narrula OS Sinus node reentry: Mechanism of supraventricular tachycardia (SVT) in man.Circulation. 1972; 46: 27Google Scholar The echo then entered the A-V node very prematurely resulting in marked A-V nodal conduction delay (not measured in Fig 4A but obviously close to 300 msec). This A-V nodal delay subsequently led to the development of a typical A-V nodal reentrant tachycardia.3Goldreyer BN Damato AN The essential role of atrioventricular conduction delay in the initiation of paroxysmal supraventricular tachycardia.Circulation. 1971; 43: 679Crossref PubMed Scopus (152) Google Scholar, 4Goldreyer BN Bigger Jr, JT Spontaneous and induced reentrant tachycardia.Ann Inter Med. 1969; 70: 87Crossref PubMed Scopus (51) Google Scholar, 5Goldreyer BN Weiss MB Damato AN Supraventricular tachycardia initiated by sinus beats.Circulation. 1971; 44: 820Crossref PubMed Scopus (15) Google Scholar, 6Bigger Jr, JT Goldreyer BN The mechanism of supraventricular tachycardia.Circulation. 1970; 42: 673Crossref PubMed Scopus (157) Google Scholar Furthermore, the ladder diagram in Figure 4A (Lozano et al) indicates that (a) the supraventricular tachycardia continues by the mechanism of intraventricular reentry, yet the V-V time of the tachycardia is 357 msec, which is above that listed as critical for intraventricular reentry (Fig 2, Lozano et al) and (b) the atrium is required for sustained reentry, an implication that is not yet substantiated even for paroxysmal A-V nodal reentrant tachycardia. An example fulfilling the first criteria of Varghese2Varghese PJ Damato AN Caracta AR et al.Intraventricular reentry: A mechanism for atrial echo beats.Am J Cardiol. 1973; 31: 163Abstract Full Text PDF Google Scholar is given in Figure 1. From top to bottom are ECG leads 1, 2, 3 and V1, high right atrial electrogram, His bundle electrogram, and time lines. In panel A at paced basic cycle length of 850 msec a premature beat is introduced at a coupling interval (A1 A2) of 330 msec. The A2-H2 and H2-V2 are 115 and 160 msec respectively and no echo is seen. In panel B a premature beat is introduced at an A1-A2 of 300 msec. The subsequent A2-H2 remains 115 msec but now the H2-V2 increases to 220 msec and at this critical H2-V2 an atrial echo ensues. Note the low atrial to high atrial sequence of the echo. A complete discussion of intraventricular reentry is in press. In conclusion, although intraventricular reentry is a mechanism of atrial echo beats and perhaps sustained supraventricular tachycardia, we do not believe that this was demonstrated in the article by Lozano et al." @default.
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• W2913413732 title "Intraventricular Reentry" @default.
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