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Europace Advance Access originally published online on April 28, 2006
Europace 2006 8(6):438-442; doi:10.1093/europace/eul037
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

ACCESSORY PATHWAYS

Pacing site and bradycardia dependent retrograde conduction block over an atrioventricular accessory pathway

Rong Bai1,2 {dagger}, Massimo Tritto3, Luigi Di Biase1 {dagger} and Jorge A. Salerno-Uriarte1,*

1 Department of Cardiovascular Science, Ospedale di Circolo e Fondazione Macchi, University of Insubria-Varese, Varese, Italy; 2 Department of Cardiology, Tong-Ji Hospital, Tong-Ji Medical College, Huazhong University of Science and Technology, Wuhan, China; 3 Department of Cardiology, Istituto Clinico Mater Domini, Castellanza, Varese, Italy

Intermittent retrograde conduction over an accessory pathway (AP) is an uncommon phenomenon. We report a case of Wolff–Parkinson–White syndrome in which retrograde conduction of the bypass tract was present only during right ventricular (RV) outflow tract and left ventricular pacing or during RV inflow tract pacing with a fast pacing rate (pacing site and bradycardia dependent conduction block). The interaction between different branches/fibres of the bypass tract might explain the mechanism of this phenomenon. The AP was successfully ablated at the lateral aspect of mitral valve annulus. It is suggested that careful evaluation by decremental ventricular stimulation should be applied from multiple sites both during baseline study and after apparent AP ablation in order to detect such uncommon cases of intermittent conduction.

Key Words: Atrioventricular accessory pathway, Catheter ablation, Pacing site dependent, Phase 4 block, Retrograde conduction

* Corresponding author. Tel: +39 332 278 937; fax: +39 332 393 309. E-mail address: jorge.salerno{at}ospedale.varese.it


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R. Rordorf, A. Vicentini, B. Petracci, and M. Landolina
Intermittent rate-dependent retrograde conduction over a concealed atrioventricular accessory pathway: what is the mechanism?
Europace, February 1, 2009; 11(2): 260 - 262.
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