Key result
Catheter-induced mechanical stimulation of the left anterolateral accessory pathway caused an unintentional resetting phenomenon during orthodromic atrioventricular reciprocating tachycardia.
Case Report (n=1)
Direct mechanical stimulation by an ablation catheter can induce an electrophysiological resetting phenomenon in an accessory pathway, aiding in successful ablation.
May aid accessory pathway localization in AVRT ablation; leaves open generalizability beyond this single case.
An 80-year-old woman was admitted to our hospital for treatment of paroxysmal supraventricular tachycardia which had been increased sharply after the antiarrhythmic drug was decreased. Electrophysiological study demonstrated orthodromic atrioventricular reciprocating tachycardia via the left anterolateral accessory pathway with relatively slow concealed conduction, which we supposed to be a target for catheter ablation. Interestingly, only while the ablation catheter tip was being placed just on the accessory pathway, the tachycardia cycle length was occasionally altered with the atrial sequence advancing forward a little, and the culprit pathway was successfully ablated at this point. We concluded, based on some electrophysiological findings, that this phenomenon was caused by electrophysiological mechanism of resetting, certainly induced by direct mechanical stimulation onto the accessory pathway.
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Matsusaka et al. (2017) conducted a case report in Paroxysmal supraventricular tachycardia (n=1). Catheter ablation (mechanical stimulation) was evaluated on Observation of resetting phenomenon and successful ablation. Catheter-induced mechanical stimulation of the left anterolateral accessory pathway caused an unintentional resetting phenomenon during orthodromic atrioventricular reciprocating tachycardia.
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