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Multiple circus movement tachycardias with multiple accessory pathways.

W F Heddle, P Brugada, H J Wellens

    Journal of the American College of Cardiology
    |July 1, 1984
    PubMed
    Summary
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    This study details a patient with Wolff-Parkinson-White syndrome experiencing four tachycardias. Two accessory pathways were identified, revealing unusual initiation patterns during electrophysiological study.

    Area of Science:

    • Cardiology
    • Electrophysiology
    • Cardiac Electrophysiology

    Background:

    • Wolff-Parkinson-White syndrome is characterized by pre-excitation of the ventricles due to accessory atrioventricular pathways.
    • Tachyarrhythmias are common complications, but the presentation of multiple pathway types and initiation modes is less frequently documented.

    Observation:

    • A case study of a patient with Wolff-Parkinson-White syndrome presenting with four distinct types of tachycardia.
    • Programmed electrical stimulation was used to map the accessory pathways and analyze tachycardia mechanisms.
    • Unusual initiation of orthodromic circus movement tachycardia by antegrade atrial premature beats conducting down an accessory pathway was observed.

    Findings:

    • Identification and electrophysiological characterization of two distinct accessory atrioventricular pathways in the same patient.

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  • Documentation of four different tachycardia types, highlighting the complex arrhythmogenic potential.
  • Demonstration of a novel tachycardia initiation mechanism involving an atrial premature beat and antegrade accessory pathway conduction.

    • Implications:

    • Enhanced understanding of the electrophysiological substrate in complex Wolff-Parkinson-White syndrome cases.
    • Potential for refining diagnostic and therapeutic strategies for patients with multiple accessory pathways.
    • Contribution to the knowledge base regarding the diverse mechanisms of supraventricular tachycardia initiation and perpetuation.