Refractory periods of the accessory pathway in the Wolff Parkinson White syndrome

Antegrade (AERPAP) and retrograde (RERPAP) effective refractory periods of the accessory pathway were measured at multiple cycle lengths in 47 patients with the Wolff Parkinson White syndrome. In 20 patients the effect of changing cycle length on AERPAP could be determined. In 12 patients AERPAP decreased by 10-45 msec, in six it increased by 10-35 msec, and in two it was unchanged. In 13 of 15 patients in whom the effect of decreasing cycle length on RERPAP could be assessed, RERPAP decreased by 10-60 msec. In eight patients, the shortest AERPAP correlated well (r = 0.83) with the shortest R-R interval of consecutive pre excited beats in atrial fibrillation. However, predominantly normal conduction was observed in six of 28 patients with atrial fibrillation, probably because of concealment in the bypass. Therefore, induction of atrial fibrillation during electrophysiological evaluation may provide additional information. The RERPAP at the cycle length of the arrhythmia was shorter than the cycle length of reciprocating tachycardia in all but one of 21 patients. At the same or comparable cycle lengths, AERPAP was usually greater than RERPAP.