"Incessant" atrioventricular (AV) reciprocating tachycardia utilizing left lateral AV bypass pathway with a long...

Two patients with incessant or nearly incessant episodes of atrioventricular (AV) reciprocating tachycardia were studied and were found to be unique because of the location of a slowly conducting retrograde AV bypass pathway in the left lateral position. During the tachycardia in both patients, negative P waves were present not only in ECG leads II, III, and aVF, but also in leads I and aVL. The R-P'/P'-R ratios were 1.3 and 1.9, respectively. Cardiac electrophysiologic study revealed that in both tachycardias, retrograde ventriculoatrial conduction occurred utilizing a concealed left lateral AV bypass pathway with a long conduction time. Verapamil prolonged conduction over the AV bypass pathway in both patients. One patient was successfully treated with oral verapamil. The other patient underwent successful surgical interruption of the AV bypass pathway.