Key result
A functional accessory pathway compensating for complete atrioventricular block deteriorated over 28 years, resulting in symptomatic bradycardia that required a dual-chamber pacemaker.
Case Report (n=1)
Highlights the rare phenomenon of concealed AV block compensated by an accessory pathway, which can deteriorate over time and requires recognition before considering radiofrequency ablation.
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Recognize potential late failure of accessory pathway compensation in AV block; case report leaves open need for tailored long-term monitoring.
We report a case of atrioventricular (AV) block diagnosed 28 years ago compensated by a functional accessory pathway. During follow-up, the accessory pathway conduction properties at rest deteriorated while the refractory properties were unchanged. At 46 years, the patient became symptomatic from bradycardia and a dual-chamber pacemaker was implanted. Although rare, concealed AV block due to an accessory pathway has to be recognized before radiofrequency ablation.
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Sacher et al. (2009) conducted a case report in Complete atrioventricular block compensated by a functional accessory pathway (n=1). Observation of accessory pathway conduction was evaluated on Deterioration of conduction properties and symptomatic bradycardia. A functional accessory pathway compensating for complete atrioventricular block deteriorated over 28 years, resulting in symptomatic bradycardia that required a dual-chamber pacemaker.
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