1/10. False-positive exercise stress electrocardiogram due to accessory pathway in the absence of manifest preexcitation.False-positive exercise testing in patients with an accessory pathway has been described only in patients with manifest preexcitation during exercise. We describe a patient in whom marked ST-segment changes were seen during an exercise test in the absence of any preexcitation of the QRS complexes. The role of the accessory pathway in producing the ST changes was reaffirmed by absence of this abnormality following catheter ablation of the accessory pathway.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
2/10. Simultaneous transcatheter closure of an atrial septal defect with an amplatzer septal occluder and radiofrequency ablation of an accessory connection.This report describes the first case of simultaneous transcatheter closure of an atrial septal defect and radiofrequency ablation of an accessory connection. This was performed successfully on an 8-year-old boy and represents an attractive therapeutic alternative to surgical repair in this combination of relatively common cardiac conditions.- - - - - - - - - - ranking = 5keywords = catheter (Clic here for more details about this article) |
3/10. Intermittent noninfarction Q waves: a finding suggestive of latent preexcitation.OBJECTIVE: To describe 3 patients who presented with chest pain and intermittent Q waves on the electrocardiogram (ECG) and were subsequently found to have latent preexcitation. patients AND methods: During a span of 8 years, 3 patients were evaluated because of atypical chest pain and pathologic Q waves in the inferior leads; in all 3 patients, the Q waves were intermittent. No patient had a history of arrhythmia or had Wolff-Parkinson-White pattern on the ECG. Diagnostic and therapeutic interventions for suspected myocardial infarction included cardiac catheterization in 2 patients, intravenous thrombolytic therapy in 1 patient, and heparin in 2 patients. Ischemic heart disease was excluded in all. patients underwent pharmacological testing and/or electrophysiologic study for suspected preexcitation. RESULTS: Despite the absence of ECG markers of preexcitation, the presence of a latent accessory atrioventricular connection was confirmed in each patient by pharmacological or electrophysiologic studies. CONCLUSION: In patients who present with intermittent noninfarction Q waves, the most likely diagnosis is latent preexcitation. Clinicians need to be educated about this clinical diagnosis and encouraged to pursue confirmatory testing. Such patients should be informed about the nature and importance of their electrocardiographic abnormality.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
4/10. Fasciculoventricular pathways: clinical and electrophysiologic characteristics of a variant of preexcitation.Fasciculoventricular Fibers. INTRODUCTION: Fasciculoventricular tracts are considered a rare form of ventricular preexcitation. Few fasciculoventricular pathways have been reported, and none have been linked to a reentrant tachycardia. methods AND RESULTS: Four patients with fasciculoventricular bypass tracts underwent electrophysiologic evaluation. Two patients had a single fasciculoventricular pathway, one that inserted anteroseptally and the other in the left ventricle. Two patients also had an AV bypass tract, with anterograde conduction over the fasciculoventricular pathway during orthodromic AV reentrant tachycardia. After ablation of the AV pathways, the ECG during sinus rhythm and the electrophysiologic study showed ventricular preexcitation due to a fasciculoventricular bypass tract inserting into the right ventricle. adenosine triphosphate was helpful in the diagnostic process. CONCLUSION: Electrophysiologists should be able to make the differential diagnosis between a fasciculoventricular bypass tract and an anteroseptal accessory pathway to preclude potential harm to the AV conduction system if a fasciculoventricular pathway is targeted for catheter ablation.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
5/10. Radiofrequency catheter ablation of two accessory pathways with different unidirectional conduction properties.Simultaneous occurrence of narrow and broad QRS complex tachycardias in patients with WPW syndrome usually indicates a macroreentry in an orthodromic atrioventricular reentry-tachycardia using the AV node as antegrade and the accessory pathway as retrograde conduction and vice versa in an antidromic circuit. We report on a 32-year-old woman with WPW syndrome presenting with both a narrow and a broad QRS complex tachycardia using two accessory pathways with different unidirectional conduction properties in combination of an exclusively antegrade conducting AV node. This case report describes conventional mapping techniques and ablation of this unusual entity of a WPW syndrome.- - - - - - - - - - ranking = 4keywords = catheter (Clic here for more details about this article) |
6/10. Ventricular preexcitation following catheter ablation of the His bundle in concealed WPW syndrome.catheter ablation of the His bundle is reported in a patient with drug-refractory supraventricular tachycardia meeting standard criteria of concealed WPW syndrome (conduction of the accessory atrioventricular pathway in retrograde direction only). After successful ablation of the His bundle, anterograde conduction along the accessory pathway, to our surprise, became apparent. During twelve months of follow-up, the patient was free of the tachycardia recurrences off antiarrhythmic drugs. While the clinical problem has been solved, the patient may--in case he should develop atrial fibrillation--present with rapid anterograde conduction via the accessory pathway. Based on this experience, better electrophysiologic protocols are needed to evaluate anterograde accessory pathway conduction properties in 'concealed' WPW syndrome, thus permitting one better to decide whether and which site of ablation should be chosen in drug-refractory cases.- - - - - - - - - - ranking = 4keywords = catheter (Clic here for more details about this article) |
7/10. Accessory atrioventricular pathway at the antero-medial mitral annulus--electrophysiologic characteristics and radiofrequency catheter ablation: a case report.Accessory atrioventricular (AV) pathway located at or near the region of aorta-mitral continuity has rarely been mentioned. This report describes one such case with a concealed accessory AV pathway at the anteromedial mitral annulus adjacent to aorta-mitral continuity. The location of the accessory pathway was confirmed by successful radiofrequency catheter ablation. This patient was a 26-year-old male. His 12-lead surface ECG showed no evidence of ventricular preexcitation during sinus rhythm. The earliest retrograde atrial depolarization recorded from the routine catheters was at the His bundle area during ventricular pacing and orthrodromic AV reentrant tachycardia; paradoxically, the earliest left-sided atrial activation recorded from the coronary sinus catheters was at the distal coronary sinus area. The unique retrograde atrial activation sequence over the left atrium and His bundle area was not true for patients with left lateral or anterolateral accessory pathway. During tachycardia, the local electrogram from the successful ablation site showed local VA fusion in the anteromedial mitral annulus. After delivering one pulse of radiofrequency energy (30W), the accessory AV pathway was successfully eliminated without complication. This report presents a concealed left-sided accessory AV pathway at an unusual location. It is very important to describe special electrophysiologic characteristics and ablation technique in this unusual accessory pathway to improve knowledge in the era of interventional electrophysiology.- - - - - - - - - - ranking = 7keywords = catheter (Clic here for more details about this article) |
8/10. Permanent mechanical catheter ablation of an accessory pathway in a child.Permanent mechanical ablation of an accessory atrioventricular pathway was observed in an infant during intracavitary electrophysiological mapping. The persistent lack of preexcitation was confirmed during a 15-month follow-up period.- - - - - - - - - - ranking = 4keywords = catheter (Clic here for more details about this article) |
9/10. ventricular fibrillation resulting from synchronized internal atrial defibrillation in a patient with ventricular preexcitation.This case describes ventricular proarrhythmia as a result of a synchronized internal atrial defibrillation shock in a 29-year-old man with Ebstein's anomaly referred for radiofrequency ablation of a right posterior accessory pathway. During the electrophysiologic study, atrial fibrillation was induced and 3/3 msec shocks of various strengths were delivered between two decapolar defibrillation catheters in the coronary sinus and right atrial appendage. A 2.0-J biphasic shock synchronized to an R wave after a short-long-short ventricular cycle length pattern with a preshock coupling interval of 245 msec induced ventricular fibrillation, which was externally defibrillated with 200 J. This observation has implications for the development of implantable atrial defibrillators.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
10/10. Pseudoinfarction pattern in an infant.A 4-week-old female infant presented with congestive heart failure, moderate mitral regurgitation, and an electrocardiographic pattern of anterolateral myocardial infarction. angiography revealed normal coronary arteries and moderate mitral regurgitation. A single-catheter electrophysiology study confirmed the presence of an accessory atrioventricular conduction pathway.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
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