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Europace Advance Access published online on May 10, 2006
Europace, doi:10.1093/europace/eul032
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© The European Society of Cardiology 2006. All rights reserved
Received August 13, 2005
Accepted February 26, 2006

Article

Evidence for an incomplete mitral isthmus block after failed ablation of a left postero-inferior concealed accessory pathway

Agustín Bortone 1 *, François Brigadeau 2, Jean Luc Pasquié 1, and Dominique Lacroix 2

1 Service de Cardiologie A, Centre Hospitalo-Universitaire de Montpellier, Hôpital Arnaud de Villeneuve, 371, avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
2 Service de Cardiologie A, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, Lille, France

* To whom correspondence should be addressed.
Agustín Bortone, E-mail: a-bortone{at}chu-montpellier.fr


  Abstract

We report the case of a young woman in whom previous ablation of a concealed left-sided accessory pathway (AP) created an iatrogenic mitral block. The mitral block was responsible for a split retrograde atrial activation pattern during orthodromic atrioventricular re-entrant tachycardia (AVRT). The differential diagnoses are discussed. The AP was ablated at the site with the shortest interval between the ventricular signal and the earliest component of the retrograde atrial activation. Meticulous mapping is paramount during AVRT with an unusual retrograde atrial activation pattern.

Keywords: Concealed accessory pathway; Split retrograde atrial activation; Mitral isthmus block.
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