Relation Between Atrioventricular Pathways and Ventricular Response During Atrial Fibrillation and Flutter

We have analysed the ventricular response as seen on the surface electrocardiogram in patients with paroxysmal atrial fibrillation and flutter in relation to the electrophysiological properties of the corresponding atrioventricular pathways. In 15 patients who had atrial fibrillation with conduction solely through the atrioventricular node, there was a significant correlation between th shortest and mean RR intervals during atrial fibrillation and the functional refractory period, "pre-Wenckebach cycle length", and the shortest ventricular cycle length that resulted from 1:1 atrioventricular conduction. In 18 patients with conduction through an accessory atrioventricular pathway the only good correlation was between the shortest and mean ventricular rate during atrial fibrillation and the "pre-Wenckebach cycle length" and shortest ventricular cycle length during 1:1 atrioventricular conduction. In 12 patients with an atriofascicular bypass tract or rapidly conducting atrioventricular node there was no significant correlation between the RR intervals during atrial fibrillation and the electrophysiological indices; the same lack of correlation was evident in all 11 patients with atrial flutter, all of whom had atrioventricular nodal conduction. The response of atrioventricular pathways to electrophysiological testing, particularly the use of incremental atrial pacing, provides useful guidance in the further management of these atrial arrhythmias.