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Case Reports
. 2023 Jun 7;9(9):606-609.
doi: 10.1016/j.hrcr.2023.06.001. eCollection 2023 Sep.

A case of ventricular-atrial conduction near tachycardia rate via a concealed atrioventricular accessory pathway located anterior to the right pulmonary vein

Tomoyuki Nakanishi  1 , Katsunori Okajima  1 , Yuichi Nagamatsu  1 , Yoshio Ohnishi  1
Affiliations
Case Reports

A case of ventricular-atrial conduction near tachycardia rate via a concealed atrioventricular accessory pathway located anterior to the right pulmonary vein

Tomoyuki Nakanishi et al. HeartRhythm Case Rep. .
No abstract available

Keywords: Accessory pathway; Adenosine triphosphate; Atrioventricular reentrant tachycardia; Rate-dependent retrograde conduction; Supraventricular tachycardia.

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Figures

Figure 1
Figure 1
Ventricular pacing during sinus rhythm. A-1: During ventricular pacing at 110 beats per minute (bpm), 2:1 ventricular-atrial (VA) conduction is shown, with the earliest atrial activation (Ae) in the His bundle region (paper speed 50 mm/s). B-1: During ventricular pacing at 150 bpm, 1:1 VA conduction is shown, with the Ae in CS 7–8 (paper speed 50 mm/s). C-1: During ventricular pacing at 170 bpm, 2:1 VA conduction is shown, with the Ae in CS 7–8 (paper speed 50 mm/s). A-2, B-2, C-2: Magnified waveforms of A-1, B-1, and C-1, respectively (paper speed 200 mm/s). CS = coronary sinus; d = distal; His = His bundle; p = proximal; RV = right ventricle; S1 = stimulus artifact.
Figure 2
Figure 2
Adenosine triphosphate (ATP) administration during right ventricle (RV) pacing. A: When ATP 20 mg is administered during RV pacing at 100 beats per minute, 1:1 ventricular-atrial conduction is transiently observed, and the earliest atrial activation site (Ae) is coronary sinus (CS) 7–8 (paper speed 50 mm/s). B: Magnified waveform of A (paper speed 200 mm/s). d = distal; His = His bundle electrogram; p = proximal; S1 = stimulus artifact.
Figure 3
Figure 3
Earliest atrial activation site. A: Ablation catheter is placed at the earliest activation site in the left atrium (LA). B, C: Atrial activation map during right ventricle pacing at 150 beats per minute. The earliest activation site is anterior to the right pulmonary vein (yellow arrow). D: Successful radiofrequency (RF) ablation. Ventricular or accessory pathway (AP) potentials are not found in the earliest activation site of the left atrium (LA). The AP conduction is blocked immediately after delivering RF energy. Paper speed 100 mm/s. ABL = ablation catheter; CS = coronary sinus; d = distal; His = His bundle; p = proximal; RA = right atrium; RV = right ventricle; S1 = stimulus artifact.
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References

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