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Case Reports
. 2021 Sep 15;7(12):816-819.
doi: 10.1016/j.hrcr.2021.09.004. eCollection 2021 Dec.

Selective accessory pathway-ventricle junction block proven by parahisian pacing after catheter ablation for right anteroseptal accessory pathway

Daisuke Yakabe  1 , Yusuke Fukuyama  1 , Masahiro Araki  1 , Toshihiro Nakamura  1
Affiliations
Case Reports

Selective accessory pathway-ventricle junction block proven by parahisian pacing after catheter ablation for right anteroseptal accessory pathway

Daisuke Yakabe et al. HeartRhythm Case Rep. .
No abstract available

Keywords: Accessory pathway potential; Catheter ablation; Parahisian pacing; Septal accessory pathway; Wolff-Parkinson-White syndrome.

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Figures

Figure 1
Figure 1
Atrial pacing before and after ablation. A: Accessory pathway potential (APP) and His deflection are indicated as red and blue arrows, respectively. Continuous atrial pacing shows constant A-APP interval with manifestation of preexcitation and induced clinical tachycardia with loss of APP. B: Remaining potentials after ablation are verified by atrial extrastimulation. This shows disappearance of potentials indicated by the red arrow and decremental conduction of potentials indicated by the blue arrow. This finding can confirm that the potential indicated by the red arrow is APP, and the potential indicated by the blue arrow is His deflection. CS = coronary sinus; d = distal; HB = His bundle; HRA = high right atrium; p = proximal; RCC = right coronary cusp; S = stimulus.
Figure 2
Figure 2
Intracardiac electrograms during accessory pathway ablation. Both accessory pathway potential (APP) on ablation catheter and the delta wave on the surface electrocardiogram disappear after catheter ablation. However, APP remains on the other electrode (red arrow). The small potential (His deflection) can be clearly confirmed on the electrodes of the ablation catheter, His bundle (HB), and right coronary cusp (RCC) after ablation (blue arrow). ABL = ablation catheter; CS = coronary sinus; d = distal; HRA = high right atrium; p = proximal.
Figure 3
Figure 3
Parahisian pacing after accessory pathway (AP) ablation. A: High-output pacing with both His and AP capture reveals retrograde AP and atrioventricular node (AVN) conduction. B: Lower-output pacing with AP capture alone reveals retrograde AP conduction. C: However, more lower-output pacing without His or AP capture reveals no retrograde AP conduction (retrograde AVN conduction alone). The differences of retrograde atrial activation patterns in (b) and (c) proves the existence of 2 retrograde conductions via the AVN and the remaining proximal fiber of AP. A = atrium; ABL = ablation catheter; APP = accessory pathway potential; CS = coronary sinus; d = distal; HB = His bundle; HRA = high right atrium; P = pacing; p = proximal; RCC = right coronary cusp; V = ventricle.
Supplemental Figure 1
Supplemental Figure 1
Catheter position during ablation. ABL = ablation catheter; LAO = left anterior oblique; RAO = right anterior oblique.
See this image and copyright information in PMC

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References

    1. Jackman W.M., Wang X.Z., Friday K.J., et al. Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current. N Engl J Med. 1991;324:1605–1611. - PubMed
    1. Otomo K., Gonzalez M.D., Beckman K.J., et al. Reversing the direction of paced ventricular and atrial wavefronts reveals an oblique course in accessory AV pathways and improves localization for catheter ablation. Circulation. 2001;104:550–556. - PubMed
    1. Calkins H., Kim Y.N., Schmaltz S., et al. Electrogram criteria for identification of appropriate target sites for radiofrequency catheter ablation of accessory atrioventricular connections. Circulation. 1992;85:565–573. - PubMed
    1. Silka M.J., Kron J., Halperin B.D., et al. Analysis of local electrogram characteristics correlated with successful radiofrequency catheter ablation of accessory atrioventricular pathways. Pacing Clin Electrophysiol. 1992;15:1000–1007. - PubMed
    1. Prystowsky E.N., Browne K.F., Zipes D.P. Intracardiac recording by catheter electrode of accessory pathway depolarization. J Am Coll Cardiol. 1983;1:468–470. - PubMed

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