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Europace Advance Access published online on September 5, 2007
Europace, doi:10.1093/europace/eum183
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© The European Society of Cardiology 2007. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Functional bundle branch block and orthodromic reciprocating tachycardia cycle length: do not bet on accessory pathway location

Fabrice Extramiana*, Seiji Takatsuki, Meiso Hayashi and Antoine Leenhardt

Lariboisière Hospital, APHP, Paris 7 University, Paris, France

Aims: To show 2 examples in which the analysis of the effect of bundle branch block on orthodromic reciprocating tachycardia cycle length was misleading.

Methods and results: We performed an electrophysiological study in two patients with orthodromic reciprocating tachycardia showing a transition from wide to narrow QRS during tachycardia. Our two cases of left bundle branch block during reciprocating tachycardia using infero-septal pathways show that ventricular to atrial conduction time prolongation may be larger than 30 ms and may be concealed by a shortening of atrial to ventricular conduction time. In the 2 cases, the atrial insertion of the accessory pathway could be successfully ablated from the right atria at the ostium of the coronary sinus.

Conclusions: The observation of the association between left bundle branch block and cycle length prolongation during reciprocating tachycardia may be associated with a successful ablation at the ostium of the coronary sinus.

Key Words: Accessory pathway, Ablation, Bundle branch block

* Corresponding author: Department of Cardiology, Lariboisière University Hospital, 2 rue Ambroise Paré—75475 Paris Cedex 10, France. Tel: + 33 1 49 95 86 74; fax: + 33 1 49 95 84 39. E-mail address: fabrice.extramiana{at}lrb.aphp.fr

Manuscript submitted 21 May 2007. Accepted after revision 2 August 2007.


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