Electrophysiological correlates of temporal numerosity adaptation.

Introduction: Much research has revealed the human visual system is capable to estimate numerical quantities, rapidly and reliably, in both the spatial and the temporal domain. This ability is highly susceptible to short-term plastic phenomena related to previous exposure to visual numerical information (i.e., adaptation). However, while determinants of spatial numerosity adaptation have been widely investigated, little is known about the neural underpinnings of short-term plastic phenomena related to the encoding of temporal numerical information. In the present study we investigated the electrophysiological correlates of temporal numerosity adaptation. Methods: Participants were asked to estimate the numerosity of a test sequence of flashes after being exposed to either a high or low numerous adapting sequence. Behavioral results confirmed the expected underestimation of test stimulus when this was preceded by a high numerous sequence as compared to when preceded by a low numerous sequence. Results: Electrophysiological data revealed that this behavior was tightly linked to the amplitude of the steady-state visual evoked (ssVEP) response elicited by the test stimulus. When preceded by a high numerous sequence, the test stimulus elicited larger ssVEP responses as compared to when preceded by a low numerous sequence with this pattern being robustly correlated with behavior. Finally, topographical maps showed that this difference was mostly evident across two antero-posterior distributed clusters of electrodes and correlated with changes in functional connectivity. Discussion: Taken together, our results suggest that visual plastic phenomena related to the encoding of temporal numerosity information reflect changes in rhythmic evoked activity that are likely related to long range communications between distinct brain regions.

Effects of brightness variations on a smartphone-based version of Radner reading charts.

OBJECTIVE: The purpose of this study was to evaluate the equivalence of smartphone-based measurements of near visual acuity under different screen brightness conditions with a standard near visual acuity test. METHODS: On a sample of 85 participants, we have evaluated near visual acuity with a smartphone-based version of the Radner reading chart at three distinct screen brightness levels. Results have been compared with those obtained with classical Radner paper charts. RESULTS: We have found that, when a sufficient screen brightness is employed, the smartphone-based version of the Radner reading chart produces results that are in line with the paper Radner charts while low brightness levels lead to a significant underestimation of reading acuities. This result was consistent across different refractive conditions. CONCLUSIONS: In conclusion, we have shown that handheld devices, such as smartphones, can be potentially exploited for remote measurements of near visual acuity provided a correct control of brightness screen is employed.

EEG signature of grouping strategies in numerosity perception.

The moment we see a group of objects, we can appreciate its numerosity. Our numerical estimates can be imprecise for large sets (>4 items), but they become much faster and more accurate if items are clustered into groups compared to when they are randomly displaced. This phenomenon, termed groupitizing, is thought to leverage on the capacity to quickly identify groups from 1 to 4 items (subitizing) within larger sets, however evidence in support for this hypothesis is scarce. The present study searched for an electrophysiological signature of subitizing while participants estimated grouped numerosities exceeding this range by measuring event-related potential (ERP) responses to visual arrays of different numerosities and spatial configurations. The EEG signal was recorded while 22 participants performed a numerosity estimation task on arrays with numerosities in the subitizing (3 or 4) or estimation (6 or 8) ranges. In the latter case, items could be spatially arranged into subgroups (3 or 4) or randomly scattered. In both ranges, we observed a decrease in N1 peak latency as the number of items increased. Importantly, when items were arranged to form subgroups, we showed that the N1 peak latency reflected both changes in total numerosity and changes in the number of subgroups. However, this result was mainly driven by the number of subgroups to suggest that clustered elements might trigger the recruitment of the subitizing system at a relatively early stage. At a later stage, we found that P2p was mostly modulated by the total numerosity in the set, with much less sensitivity for the number of subgroups these might be segregated in. Overall, this experiment suggests that the N1 component is sensitive to both local and global parcelling of elements in a scene suggesting that it could be crucially involved in the emergence of the groupitizing advantage. On the other hand, the later P2p component seems to be much more bounded to the global aspects of the scene coding the total number of elements while being mostly blind to the number of subgroups in which elements are parsed.

Viewing distance and character size in the use of smartphones across the lifespan.

The use of smartphones has seen an extraordinary growth in recent years, thus the understanding of visual habits associated with the use of such devices across the lifespan is becoming important. In the present study we measured viewing distance and character size in a group of non-presbyopes (n = 157) and a group of presbyopes (n = 60) while participants read a simple text message on their smartphone. Results showed that non-presbyopes use shorter viewing distances as compared to presbyopes, a behavior causing a significantly higher accommodative demand. Presbyopes also use larger character sizes and this behavior is more evident whenever difficulties in near vision emerge in the Near Activity Visual Questionnaire (NAVQ, Italian version). Nevertheless, the two groups did not differ in the measurement of angular size subtended by the smallest detail of the letters. Overall, our data reveal that non-presbyopes and presbyopes have different visual habits when using a smartphone. These differences should be considered when determining the best near correction.

Analysis and Accuracy Improvement of UWB-TDoA-Based Indoor Positioning System.

Positioning systems are used in a wide range of applications which require determining the position of an object in space, such as locating and tracking assets, people and goods; assisting navigation systems; and mapping. Indoor Positioning Systems (IPSs) are used where satellite and other outdoor positioning technologies lack precision or fail. Ultra-WideBand (UWB) technology is especially suitable for an IPS, as it operates under high data transfer rates over short distances and at low power densities, although signals tend to be disrupted by various objects. This paper presents a comprehensive study of the precision, failure, and accuracy of 2D IPSs based on UWB technology and a pseudo-range multilateration algorithm using Time Difference of Arrival (TDoA) signals. As a case study, the positioning of a 4×4m2 area, four anchors (transceivers), and one tag (receiver) are considered using bitcraze's Loco Positioning System. A Cramér-Rao Lower Bound analysis identifies the convex hull of the anchors as the region with highest precision, taking into account the anisotropic radiation pattern of the anchors' antennas as opposed to ideal signal distributions, while bifurcation envelopes containing the anchors are defined to bound the regions in which the IPS is predicted to fail. This allows the formulation of a so-called flyable area, defined as the intersection between the convex hull and the region outside the bifurcation envelopes. Finally, the static bias is measured after applying a built-in Extended Kalman Filter (EKF) and mapped using a Radial Basis Function Network (RBFN). A debiasing filter is then developed to improve the accuracy. Findings and developments are experimentally validated, with the IPS observed to fail near the anchors, precision around ±3cm, and accuracy improved by about 15cm for static and 5cm for dynamic measurements, on average.

Visual P2p component responds to perceived numerosity.

Numerosity perception is a key ability for human and non-human species, probably mediated by dedicated brain mechanisms. Electrophysiological studies revealed the existence of both early and mid-latency components of the Electrophysiological (EEG) signal sensitive to numerosity changes. However, it is still unknown whether these components respond to physical or perceived variation in numerical attributes. We here tackled this point by recording electrophysiological signal while participants performed a numerosity adaptation task, a robust psychophysical method yielding changes in perceived numerosity judgments despite physical numerosity invariance. Behavioral measures confirmed that the test stimulus was consistently underestimated when presented after a high numerous adaptor while perceived as veridical when presented after a neutral adaptor. Congruently, EEG results revealed a potential at around 200 ms (P2p) which was reduced when the test stimulus was presented after the high numerous adaptor. This result was much prominent over the left posterior cluster of electrodes and correlated significantly with the amount of adaptation. No earlier modulations were retrievable when changes in numerosity were illusory while both early and mid-latency modulations occurred for physical changes. Taken together, our results reveal that mid-latency P2p mainly reflects perceived changes in numerical attributes, while earlier components are likely to be bounded to the physical characteristics of the stimuli. These results suggest that short-term plastic mechanisms induced by numerosity adaptation may involve a relatively late processing stage of the visual hierarchy likely engaging cortical areas beyond the primary visual cortex. Furthermore, these results also indicate mid-latency electrophysiological correlates as a signature of the internal representation of numerical information.

Numerosity perception is tuned to salient environmental features.

Numerosity perception is a key ability to guide behavior. However, current models propose that number units encode an abstract representation of numerosity regardless of the non-numerical attributes of the stimuli, suggesting rather coarse environmental tuning. Here we investigated whether numerosity systems spontaneously adapt to all visible items, or to subsets segregated by salient attributes such as color or pitch. We measured perceived numerosity after participants adapted to highly numerous stimuli with color either matched to or different from the test. Matched colors caused a 25% underestimation of numerosity, while different colors had virtually no effect. This was true both for physically different colors, and for the same colors perceived as different, via a color-assimilation illusion. A similar result occurred in the acoustic domain, where adaptation magnitude was halved when the adaptor and test differed in pitch. Taken together, our results support the idea that numerosity perception is selectively tuned to salient environmental attributes.

Implicit visuospatial attention shapes numerosity adaptation and perception.

The perception of numerical quantities is susceptible to adaptation: after inspecting a numerous dot array for a few seconds a subsequent dot array is grossly underestimated. In a recent work we showed that the mere appearance of an additional numerically neutral stimulus significantly reduces the adaptation magnitude. Here we demonstrate that this reduction is likely due to a numerosity underestimation of the adaptor caused by a change of numerosity-related attentional resources deployed on the adapting stimulus. In Experiment 1 we replicated previous findings revealing a robust reduction of numerosity adaptation when an additional adaptor (even if neutral) was displayed. In Experiment 2 we used the method of magnitude estimation to demonstrate that numerosity is underestimated whenever a second task-irrelevant numerical stimulus appears on screen. Furthermore we demonstrated that the same experimental manipulations were not effective in modulating orientation adaptation magnitude as well as orientation estimation accuracy. Our results support the hypothesis of a tight relationship between numerosity perception and implicit visuospatial attention and corroborate the notion that numerosity adaptation depends on perceived rather than physical numerosity. However the lack of an effect of visuospatial attentional deployment for orientation perception suggests that attention might differently shape adaptation aftereffects for different features along the visual hierarchy.

tDCS over posterior parietal cortex increases cortical excitability but decreases learning: An ERPs and TMS-EEG study.

The application of anodal transcranial direct current stimulation (AtDCS) is generally associated with increased neuronal excitability and enhanced cognitive functioning. Nevertheless, previous work showed that applying this straight reasoning does not always lead to the desired results at behavioural level. Here, we investigated electrophysiological markers of AtDCS-mediated effects on visuo-spatial contextual learning (VSCL). In order to assess cortical excitability changes after 3 mA AtDCS applied over posterior parietal cortex, event-related potentials (ERPs) were collected during task performance. Additionally, AtDCS-induced effects on cortical excitability were explored by measuring TMS-evoked potentials (TEPs) collected before AtDCS, after AtDCS and after AtDCS and VSCL interaction. Behavioural results revealed that the application of AtDCS induced a reduction of VSCL. At the electrophysiological level, ERPs showed enhanced cortical response (P2 component) in the group receiving Real-AtDCS as compared to Sham-AtDCS. Cortical responsiveness at rest as measured by TEP, did not indicate any significant difference between Real- and Sham-tDCS groups, albeit a trend was present. Overall, our results suggest that AtDCS increases cortical response to incoming visuo-spatial stimuli, but with no concurrent increase in learning. Detrimental effects on behaviour could result from the interaction between AtDCS- and task-mediated cortical activation. This interaction might enhance cortical excitability and hinder normal task-related neuroplastic phenomena subtending learning.

Numerosity adaptation partly depends on the allocation of implicit numerosity-contingent visuo-spatial attention.

Like other perceptual attributes, numerosity is susceptible to adaptation. Nevertheless, it has never been fully investigated whether adaptation to numerosity is fully perceptual in nature or if it stems from the mixed influence of perception and attention. In the present work, we addressed this point throughout three separate experiments aiming at investigating the potential role played by visuo-spatial attentional mechanisms in shaping numerosity perception and adaptation. In Experiments 1 and 2, we showed that the magnitude of numerosity adaptation can be strongly influenced by the distribution of numerosity-contingent visuo-spatial attentional resources during the adaptation period. Results from Experiment 1 revealed a robust reduction of adaptation magnitude whenever a second numerical stimulus was presented in a diametrically opposite location from that of the adaptor, despite this second adapter being neutral as matched in numerosity with the following stimulus displayed in that location. In Experiment 2, we showed that this reduction in adaptation did not occur in cases where the second stimulus was not numerical, suggesting that attentional resources specifically related to numerosity information accounts for the results of Experiment 1. Finally, in Experiment 3, we showed that uninformative visuo-spatial cues shape numerosity discrimination judgments both at baseline and during adaptation. Taken together, our results seem to indicate that visuo-spatial attention plays a relevant role in numerosity perception and that adaptation to numerosity is actively influenced by this cognitive process.

Shaping the visual system: cortical and subcortical plasticity in the intact and the lesioned brain.

Visual system is endowed with an incredibly complex organization composed of multiple visual pathway affording both hierarchical and parallel processing. Even if most of the visual information is conveyed by the retina to the lateral geniculate nucleus of the thalamus and then to primary visual cortex, a wealth of alternative subcortical pathways is present. This complex organization is experience dependent and retains plastic properties throughout the lifespan enabling the system with a continuous update of its functions in response to variable external needs. Changes can be induced by several factors including learning and experience but can also be promoted by the use non-invasive brain stimulation techniques. Furthermore, besides the astonishing ability of our visual system to spontaneously reorganize after injuries, we now know that the exposure to specific rehabilitative training can produce not only important functional modifications but also long-lasting changes within cortical and subcortical structures. The present review aims to update and address the current state of the art on these topics gathering studies that reported relevant modifications of visual functioning together with plastic changes within cortical and subcortical structures both in the healthy and in the lesioned visual system.

Effects of different transcranial direct current stimulation protocols on visuo-spatial contextual learning formation: evidence of homeostatic regulatory mechanisms.

In the present study we tested the effects of different transcranial direct current stimulation (tDCS) protocols in the formation of visuo-spatial contextual learning (VSCL). The study comprised three experiments designed to evaluate tDCS-induced changes in VSCL measures collected during the execution of a visual search task widely used to examine statistical learning in the visuo-spatial domain. In Experiment 1, we probed for the effects of left-posterior parietal cortex (PPC) anodal-tDCS (AtDCS) at different timings (i.e. offline and online) and intensities (i.e. 3 mA and 1.5 mA). The protocol producing the more robust effect in Experiment 1 was used in Experiment 2 over the right-PPC, while in Experiment 3, cathodal-tDCS (CtDCS) was applied over the left-PPC only at a high intensity (i.e. 3 mA) but varying timing of application (offline and online). Results revealed that high intensity offline AtDCS reduced VSCL regardless of the stimulation side (Experiment 1 and 2), while no significant behavioral changes were produced by both online AtDCS protocols (Experiment 1) and offline/online CtDCS (Experiment 3). The reduced VSCL could result from homeostatic regulatory mechanisms hindering normal task-related neuroplastic phenomena.

Alpha oscillations reveal implicit visual processing of motion in hemianopia.

After lesion or deafferentation of the primary visual cortex, hemianopic patients experience loss of conscious vision in their blind field. However, due to the spared colliculo-extrastriate pathway, they might retain the ability to implicitly process motion stimuli through the activation of spared dorsal-extrastriate areas, despite the absence of awareness. To test this hypothesis, Electroencephalogram (EEG) was recorded from a group of hemianopic patients without blindsight (i.e., who performed at chance in different forced-choice tasks), while motion stimuli, static stimuli or no stimuli (i.e., blank condition) were presented either in their intact or in their blind visual field. EEG analyses were performed in the time-frequency domain. The presentation of both motion and static stimuli in the intact field induced synchronization in the theta band and desynchronization both in the alpha and the beta band. In contrast, for stimuli presented in the blind field, significantly greater desynchronization in the alpha range was observed only after the presentation of motion stimuli, compared to the blank condition, over posterior parietal-occipital electrodes in the lesioned hemisphere, at a late time window (500-800 msec). No alpha desynchronization was elicited by static stimuli. These results show that hemianopic patients can process only visual signals relying on the activation of the dorsal pathway (i.e., motion stimuli) in the absence of awareness and suggest different patterns of electrophysiological activity for conscious and unconscious visual processing. Specifically, visual processing in the absence of awareness elicits an activity limited to the alpha range, most likely reflecting a "local" process, occurring within the extrastriate areas and not participating in inter-areal communication. This also suggests a response specificity in this frequency band for implicit visual processing. In contrast, visual awareness evokes changes in different frequency bands, suggesting a "global" process, accomplished by activity in a wide range of frequencies, probably within and across cortical areas.

Posterior brain lesions selectively alter alpha oscillatory activity and predict visual performance in hemianopic patients.

Alpha oscillatory frequency and amplitude have been linked to visual processing and to the excitability of the visual cortex at rest. Therefore, posterior brain lesions, which damage the neural circuits of the visual system might induce alterations in the alpha oscillatory activity. To investigate this hypothesis, EEG activity was recorded during eyes-closed resting state in patients with hemianopia with posterior brain lesions, patients without hemianopia with anterior brain lesions and age-matched healthy controls. Patients with posterior lesions revealed a selective slowdown of individual alpha frequency in both the intact and the lesioned hemisphere and a reduction of alpha amplitude in the lesioned hemisphere, resulting in an interhemispheric imbalanced oscillatory alpha activity, while no significant alterations in the alpha range were found in patients with anterior lesions. This suggests a crucial role of posterior cortices in coordinating alpha oscillations in the visual system. Moreover, right posterior lesions had a more severe reduction of individual alpha frequency and altering of the interhemispheric distribution of the alpha amplitude, in line with the notion of the prominence of the right posterior cortices in balancing the interhemispheric functioning. Crucially, the duration of the in individual alpha frequency and the interhemispheric imbalance in alpha amplitude were directly linked to visuo-spatial performance across all participants and to impaired visual detection abilities in hemianopics, therefore supporting a functional role of alpha oscillations in visual processing and suggesting that activity in this frequency range at rest represents a neurophysiological marker reliably reflecting the integrity and the functionality of the visual system in humans.

Decoupling of Early V5 Motion Processing from Visual Awareness: A Matter of Velocity as Revealed by Transcranial Magnetic Stimulation.

Motion information can reach V5/MT through two parallel routes: one conveying information at early latencies through a direct subcortical route and the other reaching V5 later via recurrent projections through V1. Here, we tested the hypothesis that input via the faster direct pathway depends on motion characteristics. To this end, we presented motion stimuli to healthy human observers at different velocities (4.4°/sec vs. 23°/sec) with static stimuli as controls while applying transcranial magnetic stimulation (TMS) pulses over V5 or V1. We probed for TMS interference with objective (two-alternative forced choice [2AFC]) and subjective (awareness) measures of motion processing at six TMS delays from stimulus onset (poststimulus window covered: ∼27-160 msec). Our results for V5-TMS showed earlier interference with objective performance for fast motion (53.3 msec) than slow motion (80 msec) stimuli. Importantly, TMS-induced decreases in objective measures of motion processing did correlate with decreases in subjective measures for slow but not fast motion stimuli. Moreover, V1-TMS induced a temporally unspecific interference with visual processing as it impaired the processing of both motion and static stimuli at the same delays. These results are in accordance with fast moving stimuli reaching V5 through a different route than slow moving stimuli. The differential latencies and coupling to awareness suggest distinct involvement of a direct (i.e., colliculo-extrastriate) connection bypassing V1 depending on stimulus velocity (fast vs. slow). Implication of a direct pathway in the early processing of fast motion may have evolved through its behavioral relevance.

Compensatory Recovery after Multisensory Stimulation in Hemianopic Patients: Behavioral and Neurophysiological Components.

Lateralized post-chiasmatic lesions of the primary visual pathway result in loss of visual perception in the field retinotopically corresponding to the damaged cortical area. However, patients with visual field defects have shown enhanced detection and localization of multisensory audio-visual pairs presented in the blind field. This preserved multisensory integrative ability (i.e., crossmodal blindsight) seems to be subserved by the spared retino-colliculo-dorsal pathway. According to this view, audio-visual integrative mechanisms could be used to increase the functionality of the spared circuit and, as a consequence, might represent an important tool for the rehabilitation of visual field defects. The present study tested this hypothesis, investigating whether exposure to systematic multisensory audio-visual stimulation could induce long-lasting improvements in the visual performance of patients with visual field defects. A group of 10 patients with chronic visual field defects were exposed to audio-visual training for 4 h daily, over a period of 2 weeks. Behavioral, oculomotor and electroencephalography (EEG) measures were recorded during several visual tasks before and after audio-visual training. After audio-visual training, improvements in visual search abilities, visual detection, self-perceived disability in daily life activities and oculomotor parameters were found, suggesting the implementation of more effective visual exploration strategies. At the electrophysiological level, after training, patients showed a significant reduction of the P3 amplitude in response to stimuli presented in the intact field, reflecting a reduction in attentional resources allocated to the intact field, which might co-occur with a shift of spatial attention towards the blind field. More interestingly, both the behavioral improvements and the electrophysiological changes observed after training were found to be stable at a follow-up session (on average, 8 months after training), suggesting long-term effects of multisensory audio-visual training. These long-lasting effects seem to be subserved by the activation of the spared retino-colliculo-dorsal pathway, which promotes orienting responses towards the blind field, able to both compensate for the visual field loss and concurrently attenuate visual attention towards the intact field. These results add to previous findings the knowledge that audio-visual multisensory stimulation promote long-term plastic changes in hemianopics, resulting in stable and long-lasting ameliorations in behavioral and electrophysiological measures.

The role of the retino-colliculo-extrastriate pathway in visual awareness and visual field recovery.

Patients with visual field defects resulting from post-chiasmatic lesions experience loss of visual function in up to one half of their visual field, with consequent impairments in their daily life activities. Therefore, effective strategies for compensating for the visual field loss are of great clinical relevance. After lesions to the primary visual pathway -which conveys visual information from the retina to the lateral geniculate nucleus, the optic radiations and, then, to the striate cortex-an alternative visual pathway, which projects from the superior colliculus to the extrastriate cortex, is usually spared in patients with visual field defects. In the present review, evidence for spared functioning of this alternative pathway in patients with visual field defects will be presented, both in terms of residual visual abilities, without awareness, for stimuli presented in the blind field, and the ability to integrate unseen visual signals presented in the blind field with concurrent auditory stimuli. Crucially, this review will discuss how the spared retino-colliculo-extrastriate pathway might be a useful tool for compensating for the loss of visual perception. Accordingly, evidence for the compensatory effects of systematic multisensory audio-visual stimulation in patients with visual field defects will be reviewed.

Audio-visual multisensory training enhances visual processing of motion stimuli in healthy participants: an electrophysiological study.

Evidence from electrophysiological and imaging studies suggests that audio-visual (AV) stimuli presented in spatial coincidence enhance activity in the subcortical colliculo-dorsal extrastriate pathway. To test whether repetitive AV stimulation might specifically activate this neural circuit underlying multisensory integrative processes, electroencephalographic data were recorded before and after 2 h of AV training, during the execution of two lateralized visual tasks: a motion discrimination task, relying on activity in the colliculo-dorsal MT pathway, and an orientation discrimination task, relying on activity in the striate and early ventral extrastriate cortices. During training, participants were asked to detect and perform a saccade towards AV stimuli that were disproportionally allocated to one hemifield (the trained hemifield). Half of the participants underwent a training in which AV stimuli were presented in spatial coincidence, while the remaining half underwent a training in which AV stimuli were presented in spatial disparity (32°). Participants who received AV training with stimuli in spatial coincidence had a post-training enhancement of the anterior N1 component in the motion discrimination task, but only in response to stimuli presented in the trained hemifield. However, no effect was found in the orientation discrimination task. In contrast, participants who received AV training with stimuli in spatial disparity showed no effects on either task. The observed N1 enhancement might reflect enhanced discrimination for motion stimuli, probably due to increased activity in the colliculo-dorsal MT pathway induced by multisensory training.

[Hypothermia in the elderly: a shivering case]. / L'ipotermia nell'anziano: un caso da brividi.

Hypothermia is a medical emergency in patients with a body temperature lower than 35 degrees C (95 degrees F) due to prolonged exposure to ambient cold temperatures without appropriate protection. This condition has a 5-fold increased risk of death in the elderly. Usually, diagnosis is suggested by warning signs and symptoms like lethargy, weakness and loss of coordination, confusion and reduced respiratory or heart rate. We report the case of a 76-year-old woman who was referred to our center for symptomatic sinus bradycardia and with typical electrocardiographic abnormalities (Osborn wave) that suggested the diagnosis of severe hypothermia.

[Atrioventricular nodal reentrant tachycardia with 2:1 anterograde block]. / Tachicardia reciprocante nodale con blocco 2:1 della conduzione anterograda.

We describe the case of a patient who presented with narrow QRS tachycardia at a rate of 100 b/min. The R-R intervals were constant, and negative P waves were evident in the inferior leads, midway between two ventricular complexes. A few minutes later, the tachycardia rate suddenly increased to 190 b/min, and the electrocardiographic pattern became typical of atrioventricular nodal reentrant tachycardia. Intravenous verapamil succeeded in restoring sinus rhythm. These data suggested an atrioventricular nodal reentrant tachycardia that at the beginning was associated with a 2:1 anterograde block.