Key result
Low anterior septal catheter ablation abolishes accessory pathway conduction while preserving AV nodal function.
Why the study?
The electrophysiologic characteristics and ablation targets of decremental atriofascicular accessory pathways with bidirectional conduction in complex congenital heart disease are not well described.
Case Report (n=1)
Demonstrates successful radiofrequency ablation of a rare decremental atriofascicular accessory pathway with bidirectional conduction in a patient with complex congenital heart disease.
May inform ablation approaches in rare atriofascicular pathways with congenital disease; leaves open reproducibility and long-term outcomes.
A 17-year-old girl with a corrected complex congenital heart disease and recurrent episodes of supraventricular tachycardia was referred for catheter ablation. Electrophysiologic studies revealed the presence of an accessory pathway (AP) with bidirectional conduction and decremental properties. We demonstrated a course parallel to the node-His AV conduction system. Transient abolition of the bidirectional conduction through the AP was obtained by radiofrequency application to the ventricular insertion located in the distal right bundle branch and to the atrial insertion, located in the mid-anterior atrial septum. Radiofrequency application at the low anterior atrial septum, above the His bundle, successfully abolished AP conduction without affecting AV nodal conduction. Demonstration of the course and insertions of the AP, its bidirectional decremental conduction properties, and the association with a complex congenital heart disease are exceptional and interesting findings and raise the possibility of an accessory AV node with a parallel conduction pathway to the right bundle branch.
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Peinado et al. (2001) conducted a case report in Supraventricular tachycardia and corrected complex congenital heart disease (n=1). Radiofrequency catheter ablation was evaluated on Abolition of accessory pathway conduction. Radiofrequency catheter ablation at the low anterior atrial septum successfully abolished accessory pathway conduction without affecting AV nodal conduction.
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