Characteristics of Decremental Accessory Pathways in Children

Abstract

Background-Although retrograde decremental accessory pathways (DAPs) are thought to typically present as permanent junctional reciprocating tachycardia (permanent junctional reciprocating tachycardia), they may also be diagnosed unexpectedly during electrophysiology study. We aimed to compare the clinical and electrophysiological characteristics of patients with DAPs to an age-matched cohort with nondecremental accessory pathways. Data CollectionClinical presentation, including age at diagnosis, age at onset of symptoms, presenting symptoms, orthodromic atrio-ventricular tachycardia (ORT) rate, emergency room visits, presence of ventricular dysfunction at any point in their care, and medication management prior to EPS were recorded. Furthermore, the medical record was queried to determine whether the patient was suspected of having clinical PJRT (defined in definitions section below) based on the evaluation of the pediatric electrophysiologist before the EPS. EPS data were reviewed to identify the location and electrophysiological properties of the accessory pathways and the electrophysiological properties of the AV node. This included measurements of the ventriculo-atrial (VA) conduction times during ventricular pacing and ORT. Ablation modality, outcome, and associated complications were recorded.

Long-term outcome of neonates and infants with permanent junctional reciprocating tachycardia. When cardiac ablation changes natural history

“…The mechanism for the tachycardia is an exclusively retrograde conduction accessory pathway with slow and decremental properties. Consistent with prior reports, the most frequent location of the accessory pathway in our series was the right posteroseptal region [14].…”

Electrophysiologic approach to diagnosis and ablation of patients with permanent junctional reciprocating tachycardia associated with complex anatomy and/or physiology

“…Left‐sided inputs to the AV node are usually ablated at the roof of the CS, the left paraseptal region, or just more lateral on the mitral annulus 19 . In addition, others have also reported dual atrial insertion sites in patients with PJRT 7,20,21 . It is not completely clear why AVNRT was not inducible in case in either of the first two procedures, despite pacing and isoproterenol, but may have been due to the effects of sedation and alteration of autonomic tone on pathway conduction and refractoriness.…”

“…[1][2][3] PJRT typically is an incessant narrow complex tachycardia that involves retrograde conduction over a single slowly conducting, decremental right posteroseptal atrioventricular (AV) bypass tract that usually inserts in or near the coronary sinus (CS) os. 1,[4][5][6][7] Atypical left free wall decremental pathways have been reported. 8,9 Not only decremental pathways can cause incessant tachycardia, but incessant atrial tachycardia, atrioventricular nodal reentrant tachycardia (AVNRT), and concealed nodofascicular/ nodoventricular have all been described.…”

“…Permanent junctional reciprocating tachycardia (PJRT) was first described by Coumel et al in 1967 and has since been mostly described in infants and children 1–3 . PJRT typically is an incessant narrow complex tachycardia that involves retrograde conduction over a single slowly conducting, decremental right posteroseptal atrioventricular (AV) bypass tract that usually inserts in or near the coronary sinus (CS) os 1,4–7 . Atypical left free wall decremental pathways have been reported 8,9 .…”

Radiofrequency catheter ablation in pediatric population: clinical, electrophysiological and therapeutic characteristics in a Peruvian pediatric hospital

“…En niños con corazones estructuralmente normales, el mecanismo más común de taquicardia supraventricular es la reentrada auriculoventricular por vía accesoria, cuya ubicación es variable, seguida por la taquicardia por reentrada intranodal y la taquicardia auricular focal. La primera es más común en niños pequeños, mientras que la taquicardia por reentrada nodal o intranodal tiende a ocurrir en adolescentes y jóvenes (2,(13)(14)(15) . El estudio electrofisiológico, junto con la ablación cardiaca, generalmente por radiofrecuencia, forman parte de nuestro arsenal diagnóstico y terapéutico, y es el único método por el cual determinamos el mecanismo exacto de la taquicardia, pudiéndose identificar la ubicación de la vía accesoria, si es que está presente; sin embargo, cuenta con ciertas restricciones respecto al peso mínimo recomendado (el paciente debe pesar más de 15 kg) (1) .…”