Key result
Radiofrequency ablation of the slow pathway of the AV node successfully eliminated the inducibility of a rare narrow QRS tachycardia with atrioventricular dissociation.
Why the study?
Concealed nodoventricular fiber is a very rare retrograde accessory pathway in SVT with AV dissociation, with only a few cases of successful ablation reported.
Case Report (n=1)
No
Narrow QRS tachycardia with AV dissociation can be induced by a rare concealed nodoventricular fiber and successfully treated with RF ablation by targeting the earliest retrograde atrial potential.
Answers are grounded in this paper and cite their sources.
May support slow pathway ablation for rare tachycardias with AV dissociation; hypothesis-generating and requires validation in larger series.
BACKGROUND: Most Mahaim fibers are right free-wall atriofascicular accessory pathways with only antegrade conduction. Concealed Mahaim fiber is not very rare; however, concealed nodoventricular fiber is a very rare kind of retrograde accessory pathway in supraventricular tachycardia with atrioventricular (AV) dissociation. Only a few cases about successful ablation of the nodoventricular accessory pathway have been reported. We describe the case of a 32-year-old woman who underwent an electrophysiology study and radiofrequency (RF) ablation of a rare narrow QRS tachycardia with AV dissociation. CASE SUMMARY: A 32-year-old woman with a history of paroxysmal palpitation was admitted to our hospital for RF ablation. Electrocardiography revealed a narrow QRS complex tachycardia with the same morphology in sinus rhythm. Echocardiography showed no structural heart disease. A right-sided concealed AV accessory pathway and a right-sided concealed nodoventricular accessory pathway were involved in the orthodromic atrioventricular reciprocating tachycardia. His bundle-ventricular interval during tachycardia was the same as that in sinus rhythm. The tachycardia could be initiated and entrained by ventricular pacing. Premature right ventricular stimulus introduced during the His-bundle refractory period when tachycardia occurred was able to advance the next atrial potential. The earliest atrial activation was mapped near the proximal slow AV nodal pathway. RF ablation of both accessary pathways was successfully performed under the guidance of a three-dimensional mapping system by recording the earliest retrograde atrial potential, and tachycardia could no longer be induced. CONCLUSION: Narrow QRS tachycardia with AV dissociation is inducible by concealed nodoventricular fiber and ablated by recording the earliest retrograde atrial potential.
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Zhu et al. (2020) conducted a case report in Narrow QRS tachycardia with atrioventricular dissociation (n=1). Radiofrequency ablation was evaluated on Tachycardia inducibility. Radiofrequency ablation of the slow pathway of the AV node successfully eliminated the inducibility of a rare narrow QRS tachycardia with atrioventricular dissociation.
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