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Establishment of Deep Hypothermic Circulatory Arrest in Rats
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Published on: December 16, 2022

'Hibernating' accessory pathway.

Bobby John1, Yash Y Lokhandwala

  • 1Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu. bobeck@cmcvellore.ac.in

Indian Heart Journal
|November 29, 2008
PubMed
Summary
This summary is machine-generated.

A rare case of a hibernating accessory pathway emerged in an adolescent after initial ablation, causing recurrent tachycardia. This second pathway was successfully ablated, resolving the patient's symptoms.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Pediatric Cardiology

Background:

  • Recurrent narrow QRS tachycardia can be caused by accessory pathways.
  • Accessory pathways facilitate atrioventricular re-entry tachycardia.
  • Successful ablation typically resolves tachycardia, but complex cases exist.

Observation:

  • A 13-year-old boy with recurrent tachycardia initially showed a left lateral accessory pathway.
  • Following ablation, a new right-sided accessory pathway emerged, causing recurrent tachycardia.
  • The newly identified pathway exhibited specific refractory periods and inducible orthodromic atrioventricular re-entry tachycardia.

Findings:

  • A concealed left lateral accessory pathway was initially identified and ablated.
  • Post-ablation, a 'hibernating' right anterolateral accessory pathway became symptomatic.
  • Electrophysiology confirmed the new pathway's characteristics and inducibility of tachycardia.
  • Successful ablation of the second accessory pathway resolved the patient's symptoms.

Implications:

  • This case highlights the potential for 'hibernating' accessory pathways to emerge and become symptomatic after ablation of another pathway.
  • It underscores the importance of comprehensive electrophysiological evaluation in complex tachycardia cases.
  • The findings contribute to understanding accessory pathway behavior and management strategies in adolescents.