Characteristics of antegrade-only accessory pathways in children and adolescents

2021 ◽  
pp. 1-5
Author(s):  
Minh B. Nguyen ◽  
Allison C. Hill ◽  
Yaniv Bar-Cohen ◽  
Michael J. Silka
Keyword(s):  
High Risk ◽  
Refractory Period ◽  
Accessory Pathway ◽  
Young Patients ◽  
Atrioventricular Node ◽  
Effective Refractory Period ◽  
Accessory Pathways ◽  
Electrophysiology Study ◽  
Minimal Data ◽  
Subsequent Comparison

Abstract There is minimal data regarding antegrade-only accessory pathways in young patients. Given evolving recommendations and treatments, retrospective analysis of the clinical and electrophysiologic properties of antegrade-only pathways in patients <21 years old was performed, with subsequent comparison of electrophysiology properties to age-matched controls with bidirectional pathways. Of 522 consecutive young patients with ventricular pre-excitation referred for electrophysiology study, 33 (6.3%) had antegrade-only accessory pathways. Indications included palpitations (47%), chest pain (25%), and syncope (22%). The shortest value for either the accessory pathway effective refractory period or the pre-excited R-R interval was taken for each patient, with the median of the antegrade-only group significantly greater than shortest values for the bidirectional group (310 [280–360] ms versus 270 [240–302] ms, p < 0.001). However, the prevalence of pathways with high-risk properties (effective refractory period or shortest pre-excited R-R interval <250 ms) was similar in both study patients and controls (13% versus 21%) (p = 0.55). Sixteen patients had a single antegrade-only accessory pathway and no inducible arrhythmia. Six patients had Mahaim fibres, all right anterolateral with inducible antidromic reciprocating tachycardia. However, 11 patients with antegrade-only accessory pathways and 3 with Mahaim fibres had inducible tachycardia due to a second substrate recognised at electrophysiology study. These included concealed accessory pathways (7), bidirectional accessory pathways (5), and atrioventricular node re-entry (2). Antegrade-only accessory pathways require comprehensive electrophysiology evaluation as confounding factors such as high-risk conduction properties or inducible Supraventricular Tachycardia (SVT) due to a second substrate of tachycardia are often present.

scholarly journals Abolishment of high-risk left lateral accessory pathway by myocardial infarction: a blessing in disguise? A case report

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Jim O’Brien ◽  
Nikola Kozhuharov ◽  
Shui Hao Chin ◽  
Mark Hall
Keyword(s):  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Case Report ◽  
High Risk ◽  
Coronary Sinus ◽  
Refractory Period ◽  
Accessory Pathway ◽  
Coronary Syndrome ◽  
Electrophysiology Study ◽  
Anomalous Coronary

Abstract Background Antegradely conducting left lateral accessory pathways are a risk for supraventricular tachycardias and pre-excited atrial fibrillation. Rarely, an anomalous coronary sinus can cause difficulty in locating the pathway. The left circumflex coronary artery and obtuse marginal branches supply the posterolateral left ventricle. We describe a case report of a high-risk accessory pathway associated with an anomalous coronary sinus which, between successive electrophysiology studies, was obliterated by a felicitous acute coronary syndrome in the left circumflex territory. Case summary A 49-year-old male with palpitations and manifest pre-excitation was referred for electrophysiology study. Initial study revealed a high-risk left lateral accessory pathway with antegrade effective refractory period of 240 ms and rapidly conducting pre-excited atrial fibrillation. The coronary sinus could not be cannulated to localize the pathway. Coronary angiography and cardiac computed tomography showed an anomalous coronary sinus emptying into the right atrial free wall and patent coronaries. While awaiting repeat electrophysiology study, the patient suffered an acute coronary syndrome with immediate loss of previously visible pre-excitation on electrocardiogram, and underwent stenting of an occluded marginal branch of the circumflex. Repeat electrophysiology study demonstrated a now low-risk accessory pathway (effective refractory period 390 ms). Since infarction, the patient’s palpitations have fully settled with all subsequent electrocardiograms devoid of manifest pre-excitation. Discussion Left lateral accessory pathways, which can associate with an anomalous coronary sinus, derive from tissue similar to normal ventricular myocardium and are vulnerable to ischaemic insults in the area subtended by the circumflex artery.

Effect of adenosine on atrioventricular conduction in children and young patients with supraventricular tachycardia

1996 ◽  
Vol 6 (4) ◽  
pp. 308-314
Author(s):  
Parvin C. Dorostkar ◽  
Macdonald Dick ◽  
Gerald A. Serwer ◽  
Sarah LeRoy ◽  
Brian Armstrong
Keyword(s):  
Supraventricular Tachycardia ◽  
Accessory Pathway ◽  
Young Patients ◽  
Atrioventricular Node ◽  
Atrioventricular Conduction ◽  
Ventricular Pacing ◽  
Accessory Pathways ◽  
Before And After ◽  
Ventricular Activation ◽  
Retrograde Conduction

AbstractAdenosine, when given as an intravenous bolus, has been shown to produce atrioventricular nodal block in humans. To examine the effect of adenosine on conduction across both accessory pathways and the atrioventricular node in children, we reviewed our experience with adenosine administered during both atrial and ventricular pacing in 42 patients with atrioventricular resting tachycardia and in eight patients with atrioventricular nodal reentry tachycardia. Adenosine was administered as a mean bolus of 195 μg/kg/dose during both atrial and ventricular pacing, examining antegrade and retrograde conduction before and after radiofrequency ablation. In those patients with persistent or intermittent pre-excitation, anomalous ventricular activation was either unchanged (n=8) or increased (n=11). Retrograde conduction (either through the accessory pathway alone in three, or across both the accessory pathway and the atrioventricular node in 19) persisted in 92% of the 24 patients studied. Adenosine produced either first or third degree antegrade heart block in all patients studied without pre-excitation (those with either dual atrioventricular nodal pathways or concealed accessory pathways). Adenosine produced retrograde block in all of the eight patients with dual atrioventricular nodal pathways. In contrast, retrograde conduction persisted in 82% (14/17) of patients with concealed accessory pathways (p=0.001). When used to examine retrograde conduction, adenosine was a sensitive (82%) and highly specific (producing retrograde atrioventricular block in all patients with dual atrioventricular nodal pathways) predictor of tachycardia supported by a concealed accessory pathway. Adenosine yielded a sensitivity and specificity of 96% and a positive predictive value of 99.5% for the success of ablation of accessory pathways. These data indicate that the pattern of adenosine-induced changes in either antegrade or retrograde atrioventricular conduction, or conduction in both directions, in young patients with supraventricular tachycardia is related to the mechanism of the tachycardia. Adenosine, therefore, is a useful adjunct in the electrophysiologic evaluation of supraventricular tachycardia in children.

scholarly journals Differential effective refractory period as a useful marker of multiple accessory pathways

2019 ◽  
Vol 35 (2) ◽  
pp. 296-299
Author(s):  
Robert H. Helm ◽  
Santosh C. Varkey ◽  
Ankur A. Karnik
Keyword(s):  
Refractory Period ◽  
Effective Refractory Period ◽  
Accessory Pathways

scholarly journals Changes in electrophysiologic properties of the conductive system of the heart in children with atrioventricular nodal reentrant tachycardia after 2–8 years following radiofrequency catheter ablation of the slow pathway

Medicina ◽  
2009 ◽  
Vol 45 (8) ◽  
pp. 632 ◽  
Author(s):  
Rima Šileikienė ◽  
Dalia Bakšienė ◽  
Vytautas Šileikis ◽  
Tomas Kazakavičius ◽  
Jolanta Vaškelytė ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Refractory Period ◽  
Atrioventricular Node ◽  
Atropine Sulfate ◽  
Effective Refractory Period ◽  
Slow Pathway ◽  
Atrioventricular Nodal Reentrant Tachycardia ◽  
Reentrant Tachycardia ◽  
Fast Pathway

Radiofrequency ablation of the slow pathway is an effective method of treatment in children with atrioventricular nodal reentrant tachycardia. The aim of our study was to evaluate anterograde conduction properties in children before and after radiofrequency ablation of the slow pathway and to determine the efficacy and safety of this method. Material and methods. Noninvasive transesophageal electrophysiological examination was performed in 30 patients at the follow-up period (mean duration, 3.24 years) after radiofrequency ablation of the slow pathway. Results. The slow pathway function was observed in 13 patients one day after ablation, in 26 patients during the follow-up period, and in 28 patients after administration of atropine sulfate. Atrioventricular node conduction was significantly decreased the following day after ablation and at the follow-up versus the preablation (165.2 [30.2] bmp and 146.3 [28.5] bpm versus 190.9 [31.4] bpm; P<0.001). The atrioventricular node effective refractory period prolonged significantly the following day after ablation and at the follow-up versus the preablation (319.3 [55.3] ms and 351.0 [82.1] ms versus 248.3 [36.6] ms; P<0.001). Effective refractory period of the fast pathway prolonged significantly as compared with the preablation (from 408.0 [60.4] ms to 481.2 [132.9] ms; P=0.005). The prolongation of effective refractory period of the slow pathway was more significant than effective refractory period of the fast pathway at the follow-up (P<0.001). Two late recurrences occurred; one patient had atrial tachycardia. Conclusion. Children with atrioventricular nodal reentrant tachycardia can be effectively and safety cured by ablative therapy. The end-point during slow pathway ablation should be the abolition of tachycardia with preservation of dual atrioventricular nodal physiology.

Effects of Propofol or Isoflurane Anesthesia on Cardiac Conduction in Children Undergoing Radiofrequency Catheter Ablation for Tachydysrhythmias

1995 ◽  
Vol 82 (4) ◽  
pp. 884-887. ◽  
Author(s):  
J. Lavoie ◽  
E. P. Walsh ◽  
F. A. Burrows ◽  
P. Laussen ◽  
J. A. Lulu ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Catheter Ablation ◽  
Refractory Period ◽  
Radiofrequency Catheter Ablation ◽  
Statistical Significance ◽  
Cardiac Conduction ◽  
Effective Refractory Period ◽  
Isoflurane Anesthesia ◽  
Electrophysiology Study ◽  
Significant Difference

Background To determine suitability for ablation procedures in children, two commonly used anesthetic agents were studied: propofol and isoflurane. Methods Twenty patients presenting for a radiofrequency catheter ablation procedure were included and randomly assigned to two groups. A baseline electrophysiology study was performed during anesthesia with thiopental, alfentanil, nitrous oxide, and pancuronium in all patients. At the completion of the baseline electrophysiology study (EPS), 0.8-1.2% isoflurane was administered to patients in group 1 and 2 mg/kg propofol bolus plus an infusion of 150 micrograms.kg-1.min-1 was administered to patients in group 2. Nitrous oxide and pancuronium were used throughout the procedure. After 30 min of equilibration, both groups underwent a repeat EPS. The following parameters were measured during the EPS: cycle length, atrial-His interval, His-ventricle interval, corrected sinus node recovery time, AV node effective refractory period, and atrial effective refractory period. Using paired t tests, the electrophysiologic parameters described above measured during propofol or isoflurane anesthesia were compared to those measured during baseline anesthesia. Statistical significance was accepted as P &lt; 0.05. Results There was no statistically significant difference in the results obtained during baseline anesthesia when compared with those measured during propofol or isoflurane anesthesia. Conclusions Neither propofol nor isoflurane anesthesia alter sinoatrial or atrioventricular node function in pediatric patients undergoing radiofrequency catheter ablation, compared to values obtained during baseline anesthesia with alfentanil and midazolam.

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