1/36. Atypical AV nodal reentry with bystander accessory pathway: an unusual mechanism of preexcited tachycardia.We present an unusual mechanism of preexcited tachycardia--atypical AV nodal reentry with bystander AP. It can be differentiated from other preexcited tachycardias by its variable degree of preexcitation (either spontaneous or in response to atrial pacing), higher degree of preexcitation with pacing near the origin of the AP than during tachycardia, inability to preexcite the tachycardia by either late atrial or ventricular premature beats, the presence of nonpreexcited atypical AV nodal reentry tachycardia following successful AP ablation, and by exclusion of atrial tachycardia.- - - - - - - - - - ranking = 1keywords = accessory (Clic here for more details about this article) |
2/36. False-positive exercise stress electrocardiogram due to accessory pathway in the absence of manifest preexcitation.False-positive exercise testing in patients with an accessory pathway has been described only in patients with manifest preexcitation during exercise. We describe a patient in whom marked ST-segment changes were seen during an exercise test in the absence of any preexcitation of the QRS complexes. The role of the accessory pathway in producing the ST changes was reaffirmed by absence of this abnormality following catheter ablation of the accessory pathway.- - - - - - - - - - ranking = 1.75keywords = accessory (Clic here for more details about this article) |
3/36. Simultaneous transcatheter closure of an atrial septal defect with an amplatzer septal occluder and radiofrequency ablation of an accessory connection.This report describes the first case of simultaneous transcatheter closure of an atrial septal defect and radiofrequency ablation of an accessory connection. This was performed successfully on an 8-year-old boy and represents an attractive therapeutic alternative to surgical repair in this combination of relatively common cardiac conditions.- - - - - - - - - - ranking = 1.25keywords = accessory (Clic here for more details about this article) |
4/36. Concealed accessory pathway manifesting clinically only after pacemaker implantation.A 66-year-old man with coronary artery disease and persistent left superior vena cava received a DDDR pacemaker for symptomatic 2:1 heart block. There was no previous history of tachyarrhythmias. Endless loop tachycardia and repetitive nonreentrant ventriculoatrial synchrony occurred afterwards and were triggered by a late coupled atrial premature beat. ECGs suggested a concealed left posterior accessory pathway that was confirmed during electrophysiological study. Effective palliation was achieved with extension of the PVARP and enabling noncompetitive atrial pacing operation.- - - - - - - - - - ranking = 1.25keywords = accessory (Clic here for more details about this article) |
5/36. Pre-excitation with syncope: a false lead?An 18-year-old girl with pre-excitation presented with a history of recurrent syncope preceded by palpitation. The accessory pathway, which had a relatively long antegrade effective refractory period of 340 ms, was mapped and successfully ablated in the left lateral region. However, after ablation, she had reproducible sustained polymorphic ventricular tachycardia, which was found to be the cause of her syncope. Thus, alternate mechanisms of tachycardia need to be considered in patients with pre-excitation when the presentation is atypical.- - - - - - - - - - ranking = 0.25keywords = accessory (Clic here for more details about this article) |
6/36. A unique preexcitation pattern related to an atypical anteroseptal accessory pathway.Accessory atrioventricular pathways have traditionally been classified by anatomical location to four areas, namely anteroseptal, posteroseptal, and right and left free walls. Each of these have been associated with a relatively distinct preexicitation pattern electrocardiographically. We describe a patient with a unique ECG pattern suggesting preexicitation to the right ventricular outflow region. Preoperative and intraoperative electrophysiological testing confirmed the presence of an accessory pathway with an atrial insertion site near the His bundle, decremental anterograde conduction, and a ventricular insertion site in the upper part of the interventricular septum. Operative ablation near the atrial insertion site eliminated preexicitation.- - - - - - - - - - ranking = 1.25keywords = accessory (Clic here for more details about this article) |
7/36. Intermittent noninfarction Q waves: a finding suggestive of latent preexcitation.OBJECTIVE: To describe 3 patients who presented with chest pain and intermittent Q waves on the electrocardiogram (ECG) and were subsequently found to have latent preexcitation. patients AND methods: During a span of 8 years, 3 patients were evaluated because of atypical chest pain and pathologic Q waves in the inferior leads; in all 3 patients, the Q waves were intermittent. No patient had a history of arrhythmia or had Wolff-Parkinson-White pattern on the ECG. Diagnostic and therapeutic interventions for suspected myocardial infarction included cardiac catheterization in 2 patients, intravenous thrombolytic therapy in 1 patient, and heparin in 2 patients. Ischemic heart disease was excluded in all. patients underwent pharmacological testing and/or electrophysiologic study for suspected preexcitation. RESULTS: Despite the absence of ECG markers of preexcitation, the presence of a latent accessory atrioventricular connection was confirmed in each patient by pharmacological or electrophysiologic studies. CONCLUSION: In patients who present with intermittent noninfarction Q waves, the most likely diagnosis is latent preexcitation. Clinicians need to be educated about this clinical diagnosis and encouraged to pursue confirmatory testing. Such patients should be informed about the nature and importance of their electrocardiographic abnormality.- - - - - - - - - - ranking = 0.25keywords = accessory (Clic here for more details about this article) |
8/36. Fasciculoventricular pathways: clinical and electrophysiologic characteristics of a variant of preexcitation.Fasciculoventricular Fibers. INTRODUCTION: Fasciculoventricular tracts are considered a rare form of ventricular preexcitation. Few fasciculoventricular pathways have been reported, and none have been linked to a reentrant tachycardia. methods AND RESULTS: Four patients with fasciculoventricular bypass tracts underwent electrophysiologic evaluation. Two patients had a single fasciculoventricular pathway, one that inserted anteroseptally and the other in the left ventricle. Two patients also had an AV bypass tract, with anterograde conduction over the fasciculoventricular pathway during orthodromic AV reentrant tachycardia. After ablation of the AV pathways, the ECG during sinus rhythm and the electrophysiologic study showed ventricular preexcitation due to a fasciculoventricular bypass tract inserting into the right ventricle. adenosine triphosphate was helpful in the diagnostic process. CONCLUSION: Electrophysiologists should be able to make the differential diagnosis between a fasciculoventricular bypass tract and an anteroseptal accessory pathway to preclude potential harm to the AV conduction system if a fasciculoventricular pathway is targeted for catheter ablation.- - - - - - - - - - ranking = 0.25keywords = accessory (Clic here for more details about this article) |
9/36. Left atrial-coronary sinus dissociation following an attempt at radiofrequency ablation for a left lateral accessory pathway.coronary sinus electrograms generally represent the sequence of left atrial activation, and are very helpful in localizing and differentiating left lateral accessory pathway-mediated tachycardia from other supraventricular tachycardias. The activation of the coronary sinus from the left atrium occurs through muscle bridges, which may be discrete or form an intermingled continuum. These muscle bridges, if disconnected, may dissociate the coronary sinus from the left atrium, in which case the coronary sinus electrograms do not represent left atrial activation, and do not help to understand, or may cause misinterpretation of, the mechanism of supraventricular tachycardia. We report one such case of orthodromic supraventricular tachycardia mediated through the left lateral accessory pathway in which the coronary sinus got dissociated from the left atrium during radiofrequency ablation.- - - - - - - - - - ranking = 1.5keywords = accessory (Clic here for more details about this article) |
10/36. False-positive exercise test secondary to wolff-parkinson-white syndrome in the absence of manifest preexcitation and disappearance of ST depressions after accessory pathway ablation.wolff-parkinson-white syndrome with manifest preexcitation is a common cause of false-positive exercise test results. However, false-positive results are extremely rare without manifest preexcitation. We report a case with intermittent wolff-parkinson-white syndrome and exercise-induced marked ST depressions in the absence of preexcitation of the QRS complexes. His coronary arteries were normal on angiography and no ST changes were observed in the control exercise test after ablation of the accessory pathway.- - - - - - - - - - ranking = 1.25keywords = accessory (Clic here for more details about this article) |
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