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Concealed accessory pathway manifesting clinically only after pacemaker implantation.
1Section of Cardiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA. spinski@rush.edu
Pacing and Clinical Electrophysiology : PACE
|November 4, 2000
Summary
A patient developed tachycardia after pacemaker implantation for heart block. This was caused by a concealed accessory pathway, successfully managed by adjusting pacemaker settings.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- A 66-year-old male patient with coronary artery disease and persistent left superior vena cava underwent DDDR pacemaker implantation for symptomatic 2:1 heart block.
- The patient had no prior history of tachyarrhythmias.
Observation:
- Post-pacemaker implantation, the patient experienced endless loop tachycardia and repetitive nonreentrant ventriculoatrial synchrony.
- These events were triggered by a late-coupled atrial premature beat.
Findings:
- Electrocardiograms (ECGs) indicated a concealed left posterior accessory pathway.
- Electrophysiological study confirmed the presence of this accessory pathway.
Implications:
- Effective management was achieved by extending the post-ventricular atrial refractory period (PVARP).
- Enabling noncompetitive atrial pacing also contributed to successful palliation.
- This case highlights the importance of considering accessory pathways in pacemaker patients presenting with tachyarrhythmias.