Abstract
A 30-year-old male with electrocardiographic (ECG) evidence of manifest
pre-excitation (figure 1) was referred for an electrophysiology study
(EPS). Quadripolar catheters were placed in the His position (His) and
right ventricular apex (RVA) and a decapolar catheter was placed in the
coronary sinus (CS). Ventricular pacing (VP) with and without
isoproterenol infusion revealed poor retrograde ventriculoatrial (VA)
conduction in both the atrioventricular node (AVN) and the accessory
pathway (AP). Single atrial extra-stimuli (AES) were introduced after a
drive train at 400ms from poles CS 9,10. The following reproducible
phenomenon was observed (figure 2A, 2B). What has been unveiled, and how
is it explained?