Radiofrequency catheter ablation of an incessant supraventricular tachycardia initiated by a Hisian parasystole.
The coexistence of a parasystolic focus, tachycardia dependent right bundle branch aberrancy, and an AV accessory pathway is reported here. This condition was present in a 40-year-old man, which led to an incessant AV reciprocating tachycardia. Further electrophysiological study revealed that the parasystolic focus was located somewhere in the His bundle; endocardial mapping disclosed a right posterior accessory pathway. Radiofrequency current was delivered at the atrial level of the right posterolateral AV groove and successfully ablated the accessory pathway, leading to a dramatic improvement in cardiac function. In conclusion, the recognition of the electrophysiological mechanism of incessant supraventricular tachycardia was of crucial importance for the therapy decision. A definitive intervention using radiofrequency catheter ablation should be considered early and not postponed in patients with tachycardia-induced cardiomyopathy.
Cruz
F E
FE
Department of Arrhythmia and Electrophysiology, Hospital de Cardiologia de Laranjeiras, Rio de Janeiro, Brazil.
Fagundes
M
M
Boghossian
S
S
Ribeiro
J C
JC
Vanheusden
L
L
Maia
I G
IG
D000328:Adult; D002036:Bundle of His / Q000503:physiopathology; D002311:Cardiomyopathy, Dilated / Q000209:etiology; D017115:Catheter Ablation; D004562:Electrocardiography; D006329:Heart Conduction System / Q000601:surgery; D006801:Humans; D008297:Male; D017574:Parasystole / Q000150:complications*; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D013617:Tachycardia, Supraventricular / Q000150:complications / Q000503:physiopathology / Q000601:surgery