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Related Experiment Videos

Case report: spontaneous atriofascicular pathway automaticity simulating ventricular tachycardia.

J P Moak1, H J Moore, S W Lee

  • 1Department of Cardiology, Children's National Medical Center, Washington, DC, USA. jmoak@cnmc.org

Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing
|December 26, 2001
PubMed
Summary

Atriofascicular pathways can cause wide QRS tachycardia through automaticity, not just reentrant circuits. Radiofrequency ablation of the pathway successfully treated both reentry and automatic tachycardias in a pediatric patient.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Pediatric Arrhythmia

Background:

  • Atriofascicular pathways typically manifest as antidromic atrioventricular (AV) reentrant tachycardia.
  • Wide QRS complex tachycardia in children is often misdiagnosed as supraventricular tachycardia with aberrant conduction or ventricular tachycardia.

Observation:

  • A pediatric patient initially presented with tachycardia-induced cardiomyopathy due to presumed supraventricular tachycardia with aberrant conduction.
  • The same patient later experienced palpitations from wide QRS complex tachycardia, initially suspected as ventricular tachycardia.

Findings:

  • Electrophysiologic mapping revealed the wide QRS complex tachycardia originated from automatic activity within a right anterolateral atriofascicular pathway.
  • This pathway was also involved in a reentrant antidromic AV reciprocating tachycardia.

Related Experiment Videos

  • Radiofrequency ablation of the atriofascicular pathway effectively resolved both the automatic and reentrant tachycardias.

    • Implications:

    • This case highlights that atriofascicular pathways can be a source of wide QRS complex tachycardia through spontaneous automaticity.
    • Successful radiofrequency ablation demonstrates a targeted therapeutic approach for these complex arrhythmias.
    • Understanding this mechanism is crucial for accurate diagnosis and effective management of pediatric arrhythmias.