Emergence of Bidirectional Accessory Pathway Conduction in Adulthood

Ashish A. Nabar; Amit Vora; Yash Lokhandwala

doi:10.1111/j.1540-8167.1998.tb00948.x

June 1, 1998Journal of Cardiovascular Electrophysiology

Emergence of Bidirectional Accessory Pathway Conduction in Adulthood

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Structured PICO

P

Population

1 30-year-old woman with tachycardiomyopathy due to atrial flutter-fibrillation

I

Intervention

Radiofrequency ablation of the AV node and VVIR pacemaker implantation, followed later by radiofrequency ablation of a left lateral accessory pathway

O

Outcome

Emergence of accessory pathway conduction and successful ablation

This case highlights the unique and rare emergence of bidirectional accessory pathway conduction in adulthood following AV node ablation.

Implication

May warrant surveillance for late accessory pathway conduction after AV node ablation; leaves open mechanistic and epidemiologic questions.

Abstract

A 30-year-old woman presented with tachycardiomyopathy due to atrial flutter-fibrillation and underwent radiofrequency ablation of the AV node and VVIR pacemaker implantation. There was no evidence of any accessory pathway (AP) conduction during the AV nodal ablation or during chronic ventricular pacing. One year later, she had a transient preexcited tachycardia. A year after this, her ECG showed 1:1 AV conduction with preexcitation. Electrophysiologic study revealed a left lateral AP with anterograde and retrograde refractory periods of 280 and 240 msec, respectively. Successful radiofrequency ablation of the AP was performed. This case highlights a unique emergence of an AP in adult life.