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Accessory pathway with two conduction times
Béatrice Brembilla-Perrot1, Pierre Houriez, Daniel Beurrier
1Cardiology, CHU of Brabois, 54500 Vandoeuvre les Nancy, France. b.brembilla-perrot@chu.nancy.tr
Summary
Radiofrequency ablation successfully treated both fast and slow orthodromic tachycardias caused by a single concealed atrioventricular accessory pathway. This demonstrates a unified approach for managing reciprocating tachycardias with variable conduction times.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Arrhythmias
Background:
- Paroxysmal narrow QRS tachycardias can be caused by atrioventricular accessory pathways.
- Concealed accessory pathways may exhibit variable retrograde conduction properties, leading to tachycardias with different cycle lengths.
Observation:
- A 48-year-old male presented with frequent paroxysmal narrow QRS tachycardias.
- Tachycardias with distinct rates (220 bpm and 125 bpm) were induced, both utilizing the same left lateral concealed atrioventricular accessory pathway with differing conduction velocities.
Findings:
- Radiofrequency energy applied at the earliest site of retrograde conduction effectively suppressed both rapid and slow orthodromic tachycardias.
- This single intervention resolved reciprocating tachycardias originating from a single reentrant circuit with variable retrograde conduction.
Implications:
- Ablation targeting the earliest retrograde conduction site is a definitive treatment for tachycardias associated with a single accessory pathway, regardless of conduction variability.
- Understanding accessory pathway properties is crucial for successful catheter ablation of supraventricular tachycardias.
- This case highlights the efficacy of radiofrequency ablation in managing complex atrioventricular accessory pathway-mediated tachycardias.