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Europace Advance Access originally published online on January 5, 2006
Europace 2006 8(2):140-143; doi:10.1093/europace/euj003
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

ELECTROPHYSIOLOGY

Spontaneous automaticity of an atriofascicular accessory pathway

Santosh Kumar Dora1,*, Jaganmohan A. Tharakan2, Ajithkumar Valaparambil2, Narayanan Namboodiri2, Krishnakumar Nair2 and Thomas Peter3

Division of Cardiology Department of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Room 5353, Los-Angeles, CA 90048 USA ; Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum, Kerala 695011 India ; Cedars-Sinai Medical Center Los-Angeles, CA 90048 USA

In a 12-year-old girl with history of recurrent palpitation, an ambulatory 24 h Holter electrocardiogram showed a wide QRS complex rhythm with atrioventricular dissociation. During an electrophysiology study, an atriofascicular pathway was diagnosed with an inducible antidromic atrioventricular re-entrant tachycardia. At slower heart rates, the patient had a wide QRS complex escape rhythm similar to the tachycardia and the pre-excited QRS complex morphology. This indicates the presence of pacemaker-like cells in the atriofascicular accessory pathway giving rise to the wide QRS complex escape rhythm at a slower heart rate.

Key Words: Accessory pathway, Automaticity, Mahaim fibre, Atriofascicular pathway

Corresponding author. Tel: +1 310 276 1552; fax: +1 310 423 0318. E-mail address: kskdora{at}hotmail.com


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