Horizontal and Longitudinal Dissociation of the A‐V Node During Atrial Tachycardia

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Abstract
The co-existence of horizontal and longitudinal dissociation of the atrioventricular (A-V) node has not previously been reported. Analysis of ECG tracings from 4 patients with supraventricular tachycardias showing an irregular ventricular rate suggest that such a mechanism was responsible for the irregular A-V conduction pattern. His bundle recording was obtained in one patient and revealed the site of block to be located in the A-V node. Multi-level block and longitudinal dissociation of the A-V node is probably not rare and should be included in the discussion of supraventricular arrhythmias displaying irregular ventricular rates.