Key result
Initial catheter ablation in WPW syndrome paradoxically induces orthodromic AVRT with a long RP interval.
Why the study?
The arrhythmogenic effects of initial ablations in Wolff-Parkinson-White syndrome with complex AVRT mechanisms are not well characterized.
Case Report (n=1)
Initial unsuccessful ablation of an accessory pathway may unexpectedly alter its properties and facilitate the induction of different tachycardias.
Answers are grounded in this paper and cite their sources.
Case highlights variable AVRT induction in WPW; leaves open optimal mapping strategies for lateral pathways.
We report on a case of a 23‐year‐old male with Wolff‐Parkinson‐White syndrome. At baseline, constant right atrial pacing induced antidromic atrioventricular reentrant tachycardia (AVRT), whereas constant right ventricular (RV) pacing only revealed a normal His‐Purkinje system. Mapping below the mitral annulus during sinus rhythm revealed fusion of atrial and ventricular potentials at multiple lateral sites. After unsuccessful ablation at these sites, constant RV pacing induced a long RP interval, orthodromic AVRT with the earliest atrial site being located at an anterior aspect, where successful ablation was later achieved. These phenomena may indicate an unexpected arrhythmogenic effect of initial ablations.
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Tanaka et al. (2011) conducted a case report in Wolff-Parkinson-White syndrome (n=1). Ablation was evaluated. Initial unsuccessful ablation in a 23-year-old male with WPW syndrome unexpectedly induced an orthodromic AVRT with a long RP interval, indicating a potential arrhythmogenic effect.
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