Concealed accessory pathway manifesting clinically only after pacemaker implantation.
A 66-year-old man with coronary artery disease and persistent left superior vena cava received a DDDR pacemaker for symptomatic 2:1 heart block. There was no previous history of tachyarrhythmias. Endless loop tachycardia and repetitive nonreentrant ventriculoatrial synchrony occurred afterwards and were triggered by a late coupled atrial premature beat. ECGs suggested a concealed left posterior accessory pathway that was confirmed during electrophysiological study. Effective palliation was achieved with extension of the PVARP and enabling noncompetitive atrial pacing operation.
Pinski
S L
SL
Section of Cardiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA. spinski@rush.edu
Trohman
R G
RG
D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D006327:Heart Block / Q000628:therapy; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D011226:Pre-Excitation Syndromes / Q000175:diagnosis* / Q000503:physiopathology; D014683:Vena Cava, Superior / Q000002:abnormalities