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Catecholamine dependent accessory pathway automaticity.

Zian H Tseng1, Anil V Yadav, Melvin M Scheinman

  • 1Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA.

Pacing and Clinical Electrophysiology : PACE
|July 24, 2004
PubMed
Summary
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Automaticity from accessory pathways is rare. Following ablation for Wolff-Parkinson-White (WPW) syndrome, a patient developed a transient, catecholamine-dependent accelerated wide complex rhythm, demonstrating a rare form of automaticity.

Area of Science:

  • Electrophysiology
  • Cardiology
  • Cardiac Arrhythmias

Background:

  • The Wolff-Parkinson-White (WPW) syndrome is characterized by electrical conduction through an accessory pathway.
  • Automaticity from accessory pathways is an uncommon phenomenon.
  • Electrophysiological studies and catheter ablation are standard procedures for managing symptomatic WPW syndrome.

Observation:

  • A patient with WPW syndrome underwent repeat electrophysiological study and catheter ablation for a para-Hisian accessory pathway.
  • Following successful ablation, an isoproterenol challenge induced an accelerated wide complex rhythm.
  • This induced rhythm was dissociated from the sinus rhythm and mirrored the prior pattern of maximal pre-excitation.

Findings:

  • The observed accelerated wide complex rhythm was a form of automaticity originating from the accessory pathway.

Related Experiment Videos

  • This automatic rhythm was transient and specifically dependent on catecholamine administration (isoproterenol).
  • Post-ablation, follow-up testing, including an exercise treadmill test (ETT), showed no evidence of pre-excitation or ectopy.

    • Implications:

    • This case highlights a rare manifestation of accessory pathway automaticity.
    • It underscores the importance of considering catecholamine-induced phenomena during electrophysiological assessments.
    • Successful ablation can resolve both the primary accessory pathway conduction and secondary automatic rhythms.