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Accessory atrioventricular node with properties of a typical accessory pathway: anatomic-electrophysiologic
M H Gollob1, S Bharati, C D Swerdlow
1Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas 77030, USA. mgollob@bcm.tmc.edu
Journal of Cardiovascular Electrophysiology
|September 2, 2000
Summary
This study describes a rare accessory atrioventricular (AV) node causing ventricular preexcitation and participating in AV reentrant tachycardia (AVRT). This finding challenges previous understandings of accessory pathways and AV node function.
Area of Science:
- Cardiology
- Electrophysiology
- Pathology
Background:
- Recurrent, drug-refractory atrioventricular reentrant tachycardia (AVRT) can significantly impact patient quality of life.
- Identifying the precise anatomical substrate is crucial for effective management of complex arrhythmias.
Observation:
- A 66-year-old male with a history of myocardial infarction developed refractory AVRT.
- Electrophysiology suggested a concealed anteroseptal accessory pathway.
- Autopsy revealed a deep, para-Hisian accessory AV node, not a typical accessory pathway.
Findings:
- The identified accessory AV node was the source of ventricular preexcitation and the retrograde limb of AVRT.
- This accessory AV node was located deeper (4 mm) than typical radiofrequency ablation lesions.
- This represents the first documented case of an accessory AV node participating in AVRT.
Implications:
- This case expands the spectrum of known arrhythmogenic substrates beyond typical accessory pathways.
- Deeper anatomical structures may be involved in AVRT, necessitating advanced diagnostic and therapeutic approaches.
- Understanding accessory AV node variants is critical for improving ablation strategies and patient outcomes.