The "hidden" concealed left-sided accessory pathway: An uncommon cause of SVT in young people.
Pacing Clin Electrophysiol
; 41(4): 368-371, 2018 04.
Article
in En
| MEDLINE
| ID: mdl-29327439
ABSTRACT
BACKGROUND:
Concealed left-sided accessory pathways (CLAP) are a cause of supraventricular tachycardia (SVT) in the young. Most are mapped with right ventricular (RV) apical/outflow pacing. Rarely, alternative means of mapping are required. We review our experience from three pediatric electrophysiology (EP) centers with a rare form of "hidden" CLAP.METHODS:
All patients <21 years undergoing EP study from 2008 to 2014 with a "hidden" CLAP (defined as an accessory pathway [AP] for which RV pacing at cycle lengths [CL] stable for mapping did not demonstrate eccentric retrograde conduction) were included. EXCLUSION CRITERIA preexcitation. Demographic, procedural, and follow-up data were collected.RESULTS:
A total of 23 patients met the criteria (median age, 14.3 years [range 7-21], weight, 51 kg [31-99]). 21 (96%) had SVT and one AFIB (4%). APs were adenosine sensitive in 7/20 patients (35%) and VA conduction was decremental in six (26%). CLAP conduction was demonstrable with orthodromic reentrant tachycardia in all patients, with RV extrastimulus testing in seven (30%) and with rapid RV pacing (CONCLUSIONS:
Some CLAPs are only demonstrable with LV pacing, entrained ORT, or rapid RV pacing. LV pacing facilitated preferential AP conduction, allowing for mapping while maintaining stable hemodynamics.Key words
Full text:
1
Database:
MEDLINE
Main subject:
Tachycardia, Supraventricular
/
Epicardial Mapping
/
Accessory Atrioventricular Bundle
Type of study:
Observational_studies
Limits:
Adolescent
/
Adult
/
Child
/
Female
/
Humans
/
Male
Language:
En
Year:
2018
Type:
Article