ELECTROPHYSIOLOGY
Better ventricular synchronization via an accessory pathway
Arrhythmia Unit, Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
Manuscript submitted 20 January 2006. Accepted after revision 17 April 2006.
* Corresponding author: Pza de Curtidores No. 2, 4°Dcha 23007, Jaén, Spain. Tel: +34 637463857; fax: +34 953270692. E-mail address: maapalomares{at}secardiologia.es
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Abstract |
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 Top Abstract Case report |
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We report of a patient in whom the presence of a left ventricular accessory pathway plus enhanced AV nodal conduction led to a more physiological ventricular activation sequence than that observed after ablation of the accessory pathway in a patient with baseline left bundle branch block and concealed intra-QRS pre-excitation.
Key Words: Electrocardiogram, Ablation, Bundle branch block
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Case report |
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TopAbstractCase report |
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A symptomatic 45-year-old man with the Wolff–Parkinson–White syndrome was referred to our institution for catheter ablation. An electrophysiological study was performed with four catheters (right ventricular apex, His, coronary sinus, and right atrial appendage). The baseline electrocardiogram (Figure 1A) revealed a short PR interval, slightly slurred upstroke of the QRS, narrow QRS complexes (<120 ms), and secondary repolarization abnormalities. Atrial stimulation from the coronary sinus catheter detected the presence of a single accessory pathway located in the left ventricular free wall. Furthermore, criteria for enhanced AV nodal conduction were demonstrated. Typical left bundle branch block with wide (>120 ms) QRS complexes was observed after successful catheter ablation of the accessory pathway (Figure 1B) but with no modifications within the early portions of the QRS complexes. The same QRS morphology was evident during documented clinical and induced tachycardia (orthodromic tachycardia) (Figure 1C). Therefore, the presence of both an atrioventricular accessory pathway and enhanced AV nodal conduction led to a more physiological ventricular activation sequence than that observed after its elimination by ablation. This patient with apparent right-sided pre-excitation, in fact, had a left-sided accessory pathway with underlying left bundle branch block plus enhanced AV nodal conduction which caused concealed or subtle pre-excitation (‘intra-QRS pre-excitation’).
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