Key result
Catheter ablation may produce decremental accessory pathway conduction and rarely cause antidromic atrioventricular reciprocating tachycardia, as observed in a 15-year-old girl 8 years post-ablation.
Case Report (n=1)
Catheter ablation may rarely cause antidromic atrioventricular reciprocating tachycardia years later due to decremental accessory pathway conduction or a de novo pathway.
Raises awareness for rare late antidromic AVRT post-ablation; hypothesis-generating and should not yet change practice.
INTRODUCTION: This is a rare case of antidromic reciprocating tachycardia developing 8 years after successful catheter ablation. RESULT: A 15-year-old girl had recurrence of palpitations 8 years after the ablation of manifest right posteroseptal accessory pathway. Atrial burst pacing revealed Wenckebach atrioventricular conduction with preexcitation. Wide QRS tachycardia with identical morphology to sinus rhythm associated with retrograde His potential recorded immediately after the V-wave was induced by isoproterenol infusion. Atrial premature stimulus applied at the identical timing of His potential advanced the subsequent ventricular beat and His potential. CONCLUSION: Catheter ablation may produce decremental accessory pathway conduction and rarely cause antidromic atrioventricular reciprocating tachycardia. This may be explained by a presence of "de novo" accessory pathway with decremental conduction properties that became manifest after the first ablation.
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Sumitomo et al. (2009) conducted a case report in Antidromic atrioventricular reciprocating tachycardia (n=1). Catheter ablation was evaluated. Catheter ablation may produce decremental accessory pathway conduction and rarely cause antidromic atrioventricular reciprocating tachycardia, as observed in a 15-year-old girl 8 years post-ablation.
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