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Emergence of bidirectional accessory pathway conduction in adulthood
A Nabar1, A Vora, Y Lokhandwala
1Department of Cardiology, KEM Hospital, Parel, Mumbai, India.
Journal of Cardiovascular Electrophysiology
|July 8, 1998
Summary
This case study details the rare emergence of an accessory pathway (AP) in an adult, initially undetected after treatment for atrial flutter-fibrillation. The patient later developed preexcited tachycardia, leading to successful AP ablation.
Area of Science:
- Cardiology
- Electrophysiology
- Adult Cardiac Electrophysiology
Background:
- A 30-year-old woman with tachycardiomyopathy secondary to atrial flutter-fibrillation underwent AV nodal ablation and pacemaker implantation.
- No accessory pathway (AP) conduction was identified during the initial procedure or chronic ventricular pacing.
Observation:
- One year post-procedure, the patient experienced transient preexcited tachycardia.
- A subsequent year later, electrocardiogram (ECG) revealed 1:1 atrioventricular (AV) conduction with preexcitation.
Findings:
- Electrophysiologic study identified a left lateral AP with anterograde and retrograde refractory periods of 280 msec and 240 msec, respectively.
- Successful radiofrequency ablation of the identified accessory pathway was performed.
Implications:
- This case highlights the unique phenomenon of accessory pathway emergence in adulthood.
- It underscores the importance of considering latent accessory pathways even after initial negative findings in patients with complex arrhythmias.