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Adenosine-sensitive decremental conduction over short non-decremental atrioventricular accessory pathways after radiofrequency ablation: case series

INTRODUCTION: Decremental conduction in short anterograde atrioventricular accessory pathways (AV-APs) is rare. CASE PRESENTATION: We report on two cases with radiofrequency (RF) ablation of anterograde fast non-decremental AV-AP conduction. In Case 1, electrophysiological testing revealed fast non-...

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Autores principales: Hluchy, Jan, Van Bracht, Marc, Brandts, Bodo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6177018/
https://www.ncbi.nlm.nih.gov/pubmed/31020120
http://dx.doi.org/10.1093/ehjcr/yty040
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author Hluchy, Jan
Van Bracht, Marc
Brandts, Bodo
author_facet Hluchy, Jan
Van Bracht, Marc
Brandts, Bodo
author_sort Hluchy, Jan
collection PubMed
description INTRODUCTION: Decremental conduction in short anterograde atrioventricular accessory pathways (AV-APs) is rare. CASE PRESENTATION: We report on two cases with radiofrequency (RF) ablation of anterograde fast non-decremental AV-AP conduction. In Case 1, electrophysiological testing revealed fast non-decremental conduction over an anterograde short right posteroseptal AV-AP. During ablation, latent pre-excitation due to anterograde adenosine-sensitive slow decremental conduction over the same AV-AP manifested after eliminating its non-decremental conduction. Complete abolition of AP conduction was achieved by additional ablation. In Case 2, overt pre-excitation disappeared after the first ablation session for an anterograde short non-decremental right mid-septal AV-AP. However, latent pre-excitation due to markedly decremental conduction over the same AV-AP unmasked by intravenous adenosine and atrial pacing manoeuvers could be eliminated in a second session. DISCUSSION: This report describes unusual anterograde short non-decremental AV-APs, developing markedly slow adenosine-sensitive decremental conduction during ablation. Such AV-AP conduction properties due to RF injury may be overlooked and mask incomplete ablation and point-out careful testing including stimulation techniques and low and higher dose adenosine administration post-ablation.
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spelling pubmed-61770182019-04-24 Adenosine-sensitive decremental conduction over short non-decremental atrioventricular accessory pathways after radiofrequency ablation: case series Hluchy, Jan Van Bracht, Marc Brandts, Bodo Eur Heart J Case Rep Case Series INTRODUCTION: Decremental conduction in short anterograde atrioventricular accessory pathways (AV-APs) is rare. CASE PRESENTATION: We report on two cases with radiofrequency (RF) ablation of anterograde fast non-decremental AV-AP conduction. In Case 1, electrophysiological testing revealed fast non-decremental conduction over an anterograde short right posteroseptal AV-AP. During ablation, latent pre-excitation due to anterograde adenosine-sensitive slow decremental conduction over the same AV-AP manifested after eliminating its non-decremental conduction. Complete abolition of AP conduction was achieved by additional ablation. In Case 2, overt pre-excitation disappeared after the first ablation session for an anterograde short non-decremental right mid-septal AV-AP. However, latent pre-excitation due to markedly decremental conduction over the same AV-AP unmasked by intravenous adenosine and atrial pacing manoeuvers could be eliminated in a second session. DISCUSSION: This report describes unusual anterograde short non-decremental AV-APs, developing markedly slow adenosine-sensitive decremental conduction during ablation. Such AV-AP conduction properties due to RF injury may be overlooked and mask incomplete ablation and point-out careful testing including stimulation techniques and low and higher dose adenosine administration post-ablation. Oxford University Press 2018-04-04 /pmc/articles/PMC6177018/ /pubmed/31020120 http://dx.doi.org/10.1093/ehjcr/yty040 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Cardiology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Case Series
Hluchy, Jan
Van Bracht, Marc
Brandts, Bodo
Adenosine-sensitive decremental conduction over short non-decremental atrioventricular accessory pathways after radiofrequency ablation: case series
title Adenosine-sensitive decremental conduction over short non-decremental atrioventricular accessory pathways after radiofrequency ablation: case series
title_full Adenosine-sensitive decremental conduction over short non-decremental atrioventricular accessory pathways after radiofrequency ablation: case series
title_fullStr Adenosine-sensitive decremental conduction over short non-decremental atrioventricular accessory pathways after radiofrequency ablation: case series
title_full_unstemmed Adenosine-sensitive decremental conduction over short non-decremental atrioventricular accessory pathways after radiofrequency ablation: case series
title_short Adenosine-sensitive decremental conduction over short non-decremental atrioventricular accessory pathways after radiofrequency ablation: case series
title_sort adenosine-sensitive decremental conduction over short non-decremental atrioventricular accessory pathways after radiofrequency ablation: case series
topic Case Series
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6177018/
https://www.ncbi.nlm.nih.gov/pubmed/31020120
http://dx.doi.org/10.1093/ehjcr/yty040
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