PubMed · 10210509
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R H Anderson, S Y Ho. 1999. "Posteroseptal" accessory pathways.. https://doi.org/10.1111/j.1540-8167.1999.tb00695.x
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Accessory pathways represent abnormalities of atrioventricular conduction. According to the course and the site of insertion they can be divided into atrioventricular (AV), atrio-His, atriofascicular, nodoventricular, nodofascicular and fasciculoventricular. AV accessory pathways are the most common form. An anterior, lateral and posterior localisation of AV accessory pathways can be distinguished in the left and right free wall. Atriofascicular accessory pathways usually exhibit antegrade conduction with AV node-like decremental properties. Right atriofascicular accessory pathways are involved in most cases of Mahaim-type tachycardias. AV re-entrant tachycardia based on the presence of AV accessory pathway is mostly orthodromic, less commonly antidromic. The orthodromic AV re-entrant tachycardia based on the pathway exhibiting decremental retrograde conduction is known as permanent junctional reciprocating tachycardia. Patients with Wolff-Parkinson-White syndrome often demonstrate an atrial fibrillation. As conduction over an accessory pathway during atrial fibrillation can be rapid, some of them are at a high risk of ventricular fibrillation and sudden cardiac death. (Ref. 26.)
Retrograde conduction of the concealed accessory pathway (AP) is a prerequisite for the induction of atrioventricular reentrant tachycardia (AVRT). In patients with AVRT due to a concealed AP, the absence of retrograde conduction of the AP in the baseline state has rarely been reported. We report a case of AVRT due to a concealed left lateral AP, in which the retrograde conduction was absent in the baseline state and manifested by isoproterenol infusion. A 61-year-old man had suffered from intermittent palpitation for 17 years. A narrow QRS complex tachycardia with a retrograde P wave in the ST segment was recorded in 24-h Holter monitoring. An electrophysiologic study was performed while he was in a nonsedated state. No ventriculoatrial conduction over either the normal atrioventricular conduction system or the AP was demonstrated in the baseline state. Isoproterenol was infused at a rate of 1.0 microg/min. Retrograde conduction over the AP became manifest and AVRT was induced. The AP was ablated with radiofrequency energy at the left free wall. After ablation of the AP, no tachycardia was induced. To the authors'best knowledge, only 1 other similar case has been reported in the literature.