Fast pathway ablation in a patient with PR prolongation.

Pacing and Clinical Electrophysiology : PACE
Randa Tabbah, Bernard Abi-Saleh

Abstract

The classical form of typical atrioventricular node reentrant tachycardia (AVNRT) is a "slow-fast" pathways tachycardia, and the usual therapy is an ablation of the slow pathway since it carries a low risk of atrioventricular (AV) block. In patients with long PR interval and/or living on the anterograde slow pathway, an alternative technique is required. We report a case of a 42-year-old lady with idiopathic restrictive cardiomyopathy, persistent atrial fibrillation status post pulmonary vein isolation, and premature ventricular complex ablation with a systolic dysfunction, who presented with incessant slow narrow complex tachycardia of 110 bpm that appeared to be an AVNRT. Her baseline EKG revealed a first-degree AV block with a PR of 320 ms. EP study showed no evidence of anterograde fast pathway conduction. Given this fact, the decision was to attempt an ablation of the retrograde fast pathway. The fast pathway was mapped during tachycardia to its usual location into the anteroseptal region, then radiofrequency ablation in this location terminated tachycardia. After ablation, she continued to have her usual anterograde conduction through slow pathway and the tachycardia became uninducible. In special populations with prolong...Continue Reading

References

Mar 15, 2005·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Richard KobzaHans Kottkamp
Nov 21, 2007·Circulation·Hiroshi Nakagawa, Warren M Jackman
Sep 13, 2016·Arrhythmia & Electrophysiology Review·Demosthenes G Katritsis, Mark E Josephson
Jun 13, 2019·Journal of Cardiovascular Electrophysiology·Stephen TuohyPatrick Tchou

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