Concealed accessory pathways and related tachycardias

ESC CardioMed ◽  
2018 ◽  
pp. 2091-2092
Author(s):  
Carlo Pappone ◽  
Vincenzo Santinelli
Keyword(s):  
Catheter Ablation ◽  
Radiofrequency Catheter Ablation ◽  
Atrioventricular Node ◽  
Tricuspid Annulus ◽  
Atrioventricular Reentrant Tachycardia ◽  
Accessory Pathways ◽  
Purkinje System ◽  
Electrical Impulses ◽  
Supraventricular Tachycardias ◽  
Retrograde Conduction

Conduction from the atria to the ventricles normally occurs via the atrioventricular node–His–Purkinje system. Accessory pathways (APs) directly connect the atrium and ventricle and bypass the atrioventricular node, bridging the mitral or, less commonly, the tricuspid annulus. Concealed APs conduct electrical impulses retrogradely from the ventricles to the atria, but not antegradely from the atria to the ventricles. Approximately 40% of all APs are concealed, and orthodromic atrioventricular reentrant tachycardia due to concealed APs is present in up to 15% of patients with supraventricular tachycardias referred for catheter ablation. Most concealed APs are left-sided, exhibiting non-decremental retrograde conduction. Tachyarrhythmias due to concealed APs are managed similarly to those supraventricular tachycardias associated with manifest APs, and symptomatic tachyarrhythmias are successfully treated by radiofrequency catheter ablation in the majority of patients.

Radiofrequency catheter ablation for the treatment of supraventricular tachycardias in children and adolescents

2000 ◽  
Vol 10 (4) ◽  
pp. 376-383 ◽  
Author(s):  
Pedro Iturralde ◽  
Luís Colín ◽  
Sergio Kershenovich ◽  
Milton E. Guevara ◽  
Argelia Medeiros ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Atrial Flutter ◽  
Radiofrequency Catheter Ablation ◽  
Accessory Pathway ◽  
Atrioventricular Node ◽  
Slow Pathway ◽  
Accessory Pathways ◽  
Children And Young Adults ◽  
Supraventricular Tachycardias ◽  
Fast Pathway

AbstractWe report our experience in radiofrequency catheter ablation between April, 1992 and December, 1998, in which we treated 287 parients less than 18 years of age (mean 14.3±3.1 years) with supraventricular tachycardia. Accessory pathways were the arrhythmic substrate in 252 of the patients (87.8%), the patients having a total of 265 accessory pathways. Atrioventricular nodal re-entry was the cause of tachycardia in 26 patients (9.0%), while atrial flutter was detected in the remaining 9 patients (3.1%). We were able successfully to eliminate the accessory pathway in 236 patients (89%), but 25 patients had recurrent arrhythmias. Ablation proved successful in all cases of atrioventricular node re-entry tachycardia, the slow pathway being ablated in 25 patients, and the fast pathway in only one case. Recurrence of the arrhythmia occurred in three patients (11.5%). We performed a second ablation in these children, all then proving successful. The ablation was successful in all cases of atrial flutter, with one recurrence (11.1%). Overall, therefore, ablation was immediately successful in 271 patients (94.4%), with a recurrence of the arrhythmia in 29 cases (10.7%). The incidence of serious complications was 2.09% There was one late death due to infective endocarditis, 3 patients suffered complete heart block, 1 had mild mitral regurgitation, and 1 patient developed an haematoma in the groin. We conclude that radiofrequency catheter ablation can now be considered a standard option for the management of paroxysmal supraventricular tachycardias in children and young adults.

Risk factors of recurrence and complication in radiofrequency catheter ablation of atrioventricular reentrant tachycardia in children and adolescents

2013 ◽  
Vol 23 (5) ◽  
pp. 682-691 ◽  
Author(s):  
Tien H. Chen ◽  
Ming-Lung Tsai ◽  
Po-Cheng Chang ◽  
Hung-Ta Wo ◽  
Chung-Chuan Chou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Congenital Heart Disease ◽  
Catheter Ablation ◽  
Children And Adolescents ◽  
Radiofrequency Catheter Ablation ◽  
Congenital Heart ◽  
Accessory Pathway ◽  
Reentrant Tachycardia ◽  
Atrioventricular Reentrant Tachycardia ◽  
Accessory Pathways

AbstractBackgroundTo compare potential risk factors for complications and recurrence after radiofrequency catheter ablation in symptomatic atrioventricular reentrant tachycardia in children and adolescents.MethodsWe retrospectively reviewed the data of 213 consecutive patients with symptomatic atrioventricular reentrant tachycardia who underwent both electrophysiological study and radiofrequency catheter ablation, divided these patients into two groups, children (age <12 years) and adolescents (12 ≤ age < 18 years), and compared the location of the accessory pathway, success rate, recurrence rate, complications, presence of congenital heart disease, presence of intermittent ventricular pre-excitation, and presence of Wolff–Parkinson–White syndrome in the two groups.ResultsThe position of the accessory pathway was mostly right sided in children (61.3%) and left sided in adolescents (61.5%). Children had significantly more congenital heart disease than adolescents (6.4% versus 0.8%). Univariate analysis showed children or adolescents with right-sided accessory pathways to be 6.84 times and those with accessory pathways on both sides of the septum 25 times more likely to relapse than those with a single accessory pathway. Multivariate analysis indicated that children or adolescents with two accessory pathways were six times, and those with intermittent ventricular pre-excitation nine times more at risk of relapsing following radiofrequency ablation than those with single accessory pathways. All five complications occurred in children.ConclusionsThe findings suggest that the position and number of accessory pathways and presence of intermittent ventricular pre-excitation are related to risks of recurrence of atrioventricular reentrant tachycardia in children and adolescents.

Radiofrequency catheter ablation for supraventricular tachycardias: Part II

1994 ◽  
Vol 3 (1) ◽  
pp. 77-80
Author(s):  
LG Futterman ◽  
L Lemberg
Keyword(s):  
Catheter Ablation ◽  
Cardiac Arrhythmias ◽  
Radiofrequency Catheter Ablation ◽  
Standard Treatment ◽  
Atrioventricular Node ◽  
Complication Rates ◽  
Efficacy And Safety ◽  
Percutaneous Catheter ◽  
Radiofrequency Current ◽  
Supraventricular Tachycardias

Use of percutaneous catheter ablation with radiofrequency current for cardiac arrhythmias is expanding rapidly. Technical ease, high success and low complication rates have allowed RFCA to become standard treatment for accessory AV connections and is the therapeutic procedure of choice for patients with atrioventricular node reentry tachycardias. Techniques still being investigated and evaluated for the treatment of supraventricular tachycardias include laser catheter ablation, cryocatheter ablation and microwave catheter ablation. With further clinical experience, the efficacy and safety of these and other procedures can be determined.

Radiofrequency Catheter Ablation of Atriofascicular Accessory Pathways Guided by Discrete Electrical Potentials Recorded at the Tricuspid Annulus

1995 ◽  
Vol 18 (7) ◽  
pp. 1388-1394 ◽  
Author(s):  
JOSEF BRUGADA ◽  
JUAN MARTINEZ-SANCHEZ ◽  
BORIS KUZMICIC ◽  
MARCIO de O. FIGUEIREDO ◽  
MARIONA MATAS ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Radiofrequency Catheter Ablation ◽  
Tricuspid Annulus ◽  
Accessory Pathways ◽  
Electrical Potentials

scholarly journals Radiofrequency Catheter Ablation in Children with Supraventricular Tachycardias: Intermediate Term Follow up Results

2012 ◽  
Vol 6 ◽  
pp. CMC.S8578 ◽  
Author(s):  
Mm. Hafez ◽  
Mm. Abu-Elkheir ◽  
M. Shokier ◽  
Hf. Al-Marsafawy ◽  
Hm. Abo-Haded ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Radiofrequency Catheter Ablation ◽  
Atrioventricular Nodal Reentrant Tachycardia ◽  
Reentrant Tachycardia ◽  
Electrophysiologic Study ◽  
Atrioventricular Reentrant Tachycardia ◽  
Pediatric Age Group ◽  
Line Of Therapy ◽  
Supraventricular Tachycardias

The Purpose of the Study Radiofrequency (RF) catheter ablation represents an important advance in the management of children with cardiac arrhythmias and has rapidly become the standard and effective line of therapy for supraventricular tachycardias (SVTs) in pediatrics. The purpose of this study was to evaluate the intermediate term follow up results of radiofrequency catheter ablation in treatment of SVT in pediatric age group. Methods A total of 60 pediatric patients (mean age = 12.4 ± 5.3 years, ranged from 3 years to 18 years; male: female = 37:23; mean body weight was 32.02 ± 12.3 kg, ranged from 14 kg to 60 kg) with clinically documented SVT underwent an electrophysiologic study (EPS) and RF catheter ablation at Children's Hospital Mansoura University, Mansoura, Egypt during the period from January 2008 to December 2009 and they were followed up until October 2011. Results The arrhythmias included atrioventricular reentrant tachycardia (AVRT; n = 45, 75%), atrioventricular nodal reentrant tachycardia (AVNRT; n = 6, 10%), and atrial tachycardia (AT; n = 9, 15%). The success rate of the RF catheter ablation was 93.3% for AVRT, 66.7% for AVNRT, and 77.8% for AT, respectively. Procedure-related complications were infrequent (7/60, 11.7%), (atrial flutter during RF catheter ablation (4/60, 6.6%); ventricular fibrillation during RF catheter ablation (1/60, 1.6%); transient complete heart block during RF catheter ablation (2/60, 3.3%)). The recurrence rate was 8.3% (5/60) during a follow-up period of 34 ± 12 months. Conclusion RF catheter ablation is an effective and safe method to manage children with SVT.

Retrograde sharp potential resembling the his-bundle electrogram: is this a case of atrioventricular re-entrant tachycardia involving twin atrioventricular nodes with the anterior node exhibiting only retrograde conduction?

2020 ◽  
Vol 30 (12) ◽  
pp. 1940-1942
Author(s):  
Gaku Izumi ◽  
Hisashi Yokoshiki ◽  
Atsuhito Takeda
Keyword(s):  
Catheter Ablation ◽  
Atrioventricular Node ◽  
Anterior Wall ◽  
Atrial Pacing ◽  
His Bundle ◽  
Common Atrium ◽  
Right Isomerism ◽  
The Common ◽  
Supraventricular Tachycardias ◽  
Retrograde Conduction

AbstractA 2-year-old male with right isomerism was referred for supraventricular tachycardias. Atrial pacing study revealed that anterograde conduction was only through the posterior atrioventricular node. During the mapping of ventriculoatrial conduction, we identified a sharp potential resembling a His-bundle electrogram with a decremental property at the anterior wall of the common atrium. Catheter ablation for the potential eliminated the anterior ventriculoatrial conduction, thereby indicating retrograde activation of the possible anterior atrioventricular node.

Radiofrequency Catheter Ablation of Accessory Pathways During Entrainment of AV Reentrant Tachycardia

1994 ◽  
Vol 17 (4) ◽  
pp. 590-594 ◽  
Author(s):  
HUAGUI G. LI ◽  
GEORGE J. KLEIN ◽  
MARGO ZARDINI ◽  
RANJAN K. THAKUR ◽  
GARLOS A. MORILLO ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Radiofrequency Catheter Ablation ◽  
Reentrant Tachycardia ◽  
Accessory Pathways

scholarly journals Radiofrequency Catheter Ablation of Left Free Wall Accessory Pathways: Comparison Between Retrograde and Transeptal Approach

2012 ◽  
Vol 4 (2) ◽  
pp. 139-147
Author(s):  
S Hashem ◽  
M Hossain ◽  
MA Ali ◽  
AK Choudhury ◽  
AA Masum
Keyword(s):  
Catheter Ablation ◽  
Radiofrequency Catheter Ablation ◽  
Similar Efficacy ◽  
Vascular Complication ◽  
Free Wall ◽  
Efficacy And Safety ◽  
Accessory Pathways ◽  
Intention To Treat ◽  
Primary Success ◽  
Ablation Success

Background : This study was conducted to compare the conventional retrograde arterial approach (RAA) with the transeptal approach (TSA) for radiofrequency catheter ablation (RFA) of left accessory pathways (AP). Materials and Methods: Sixty consecutive patients (44 male; mean age of 35.60 ± 11.63 years) with 60 left APs (39 overt and 21 concealed) underwent catheter ablation using the TS method (30 patients) and the RA method (30 patients) in an alternate fashion. The analysis was performed according to the intention-to-treat principle. Results : The transeptal puncture was successfully performed in 29 patients (96%). This access allowed primary success in the ablation in all the patients without any complication. When we compared this approach with the RAA there was no difference as regards the primary success (p = 0.103), fluoroscopy time (p = 0.565) and total time (p = 0.1917). Three patient in the RAA group presented a vascular complication. The TSA allowed shorter ablation times (p=0.006) and smaller number of radiofrequency applications (p = 0.042) as compared to the conventional RAA. The patients who had unsuccessful ablation in the first session in each approach underwent with the opposite technique (cross-over), with a final ablation success rate of 100%. Conclusion : The TS and RA approaches showed similar efficacy and safety for the ablation of left accessory pathways. The TSA allowed shorter ablation times and smaller number of radiofrequency applications. When the techniques were used in a complementary fashion, they increased the final efficacy of the ablation DOI: http://dx.doi.org/10.3329/cardio.v4i2.10458 Cardiovasc. j. 2012; 4(2): 139-147

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