Document Detail

Decremental conduction properties in overt and concealed atrioventricular accessory pathways.
MedLine Citation:
PMID:  11225595     Owner:  NLM     Status:  MEDLINE    
AIM: Most atrioventricular accessory pathways (AV-APs) exhibit Kent bundle physiology characterized by fast and non-decremental conduction properties. In contrast, atriofascicular APs, which are only capable of reaching slow levels of long antegrade decremental conduction, are uncommon. The aim of this study was to describe antegrade and/or retrograde AV-APs with unusual decremental properties. METHODS AND RESULTS: Five patients with unusual decremental AV-APs underwent electrophysiological evaluation and radiofrequency catheter ablation for symptomatic tachycardias. Three were found to have structural heart disease, and three latent decremental AV-APs in the anterograde and/or retrograde direction that could not be demonstrated by routine electrophysiological testing. In Case 1, a right posteroseptal AV-AP with bidirectionally latent decremental conduction was associated with clinical antidromic circus movement tachycardia (CMT) mimicking ventricular tachycardia and orthodromic CMT, the latter inducible only with isoprenaline. In Case 2, incessant orthodromic CMT was due to a latent retrograde left posterolateral AV-AP. In both cases, double atrial responses to a single paced ventricular beat, initiating orthodromic CMT, were observed. In Case 3 with latent preexcitation unmasked by adenosine and atrial pacing, retrograde latent decremental conduction over a right posteroseptal AV-AP could be shown only with isoprenaline. This patient and the remaining two with overt preexcitation demonstrated anterograde decremental AP conduction that was discontinuous over a right posteroseptal AV-AP in Cases 3 and 4 and was continuous over a midseptal AV-AP in Case 5. In the latter case, the site of decremental conduction could be localized at the proximal AP origin. All five AV-APs were successfully ablated at the annulus level. CONCLUSION: AV-APs with unusual decremental properties that are either latent, demonstrable only during CMT or overt, exhibiting functional longitudinal dissociation are described. These APs could be identified and successfully ablated after detailed electrophysiological analysis.
J Hluchy; S Schickel; P Schlegelmilch; U Jörger; F Brägelmann; G V Sabin
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Publication Detail:
Type:  Case Reports; Comparative Study; Evaluation Studies; Journal Article    
Journal Detail:
Title:  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     Volume:  2     ISSN:  1099-5129     ISO Abbreviation:  Europace     Publication Date:  2000 Jan 
Date Detail:
Created Date:  2001-02-27     Completed Date:  2001-03-22     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  England    
Other Details:
Languages:  eng     Pagination:  42-53     Citation Subset:  IM    
Department of Cardiology and Angiology, Elisabeth Hospital, Essen, Germany.
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MeSH Terms
Adenosine / therapeutic use
Anti-Arrhythmia Agents / therapeutic use
Arrhythmias, Cardiac / physiopathology*,  therapy
Bundle of His / physiopathology*,  surgery
Cardiac Pacing, Artificial
Catheter Ablation
Electrocardiography / methods*
Heart Rate
Middle Aged
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 58-61-7/Adenosine

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