Key result
Sequential ablation of two decremental accessory pathways terminates rare AVRT independent of the AV node.
This case demonstrates that meticulous electrophysiologic study can identify and successfully guide ablation of rare pathway-to-pathway reentry mechanisms independent of the AV node.
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Supports ablation of rare dual decrementally conducting pathways; hypothesis-generating for prevalence and mapping strategies.
We report a rare case of broad complex atrioventricular reentrant tachycardia (AVRT) in an 18-year-old female, mediated by two distinct decrementally conducting accessory pathways (APs). The reentrant circuit consisted of antegrade conduction via an atrio-fascicular (AF) fiber and retrograde conduction through a concealed posteroseptal AP. Both APs exhibited decremental properties, and the circuit was independent of the atrioventricular (AV) node and His-Purkinje system, representing a classic example of pathway-to-pathway reentry. Sequential ablation of the retrograde and then the antegrade limbs successfully eliminated the arrhythmia. This case highlights the importance of meticulous electrophysiologic study (EPS) in identifying non-AV nodal dependent reentry mechanisms.
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Bisht et al. (2026) studied this question. Sequential ablation of two decrementally conducting accessory pathways successfully terminated a rare atrioventricular reentrant tachycardia independent of the AV node.
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