Key result
Incomplete accessory pathway ablation triggers long-RP orthodromic AVRT in Wolff-Parkinson-White syndrome.
Case Report (n=1)
Incomplete impairment of an AV accessory pathway during initial ablation attempts may have an unexpected arrhythmogenic effect, initiating different forms of AVRT.
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Alerts clinicians to variable pacing responses in WPW ablation; leaves open systematic study of RV maneuvers in antidromic AVRT.
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. In a patient with Wolff-Parkinson-White syndrome, unsuccessful initial ablation of an accessory pathway led to the induction of an orthodromic AVRT with a long RP interval.
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