creators_name: Haghjoo, Majid creators_name: Arya, Arash creators_name: Dehghani, Mohammadreza creators_name: Emkanjoo, Zahra creators_name: Fazelifar, Amirfarjam creators_name: Sadr-Ameli, MohammadAli editors_name: Singh, Balbir editors_name: Lokhandwala, Yash editors_name: Francis, Johnson editors_name: Gupta, Anup type: journalp datestamp: 2005-04-14 lastmod: 2011-03-11 08:55:53 metadata_visibility: show title: Multiple Arrhythmogenic Substrate for Tachycardia in a Patient with Frequent Palpitations ispublished: pub subjects: ipej full_text_status: public keywords: atrioventricular nodal reentrant tachycardia; atrioventricular reentrant tachycardia; atrial tachycardia; accessory pathway; catheter ablation abstract: We report a 26-year-old woman with frequent episodes of palpitation and dizziness. Resting electrocardiography showed no evidence of ventricular preexcitation. During electrophysiologic study, a concealed right posteroseptal accessory pathway was detected and orthodromic atrioventricular reentrant tachycardia incorporating this pathway as a retrograde limb was reproducibly induced. After successful ablation of right posteroseptal accessory pathway, another tachycardia was induced using a concealed right posterolateral accessory pathway in tachycardia circuit. After loss of retrograde conduction of second accessory pathway with radiofrequency ablation, dual atrioventricular nodal physiology was detected and typical atrioventricular nodal reentrant tachycardia was repeatedly induced. Slow pathway ablation was done successfully. Finally sustained self-terminating atrial tachycardia was induced under isoproterenol infusion but no attempt was made for ablation. During 8-month follow-up, no recurrence of symptoms attributable to tachycardia was observed. date: 2005-01 date_type: published publication: Indian Pacing and Electrophysiology Journal volume: 5 number: 1 publisher: Indian Pacing and Electrophysiology Group pagerange: 66-70 refereed: TRUE referencetext: 1. Chen SA, Cheng CC, Chiang CC, et al. Radiofrequency ablation in a patient with tachycardia incorporating triple free wall accessory pathways and atrioventricular nodal reentrant tachycardia. Am Heart J 1994;127:1656-1661. 2. Varotto L, Storti C, Salerno-Uriate JA. Radiofrequency ablation in two patients with typical and atypical atrioventricular nodal reentrant tachycardias, associated with atrioventricular reentrant tachycardias. G Ital Cardiol 1999;29:1030-1033. 3. Schlapfer J, Goy JJ. Radiofrequency catheter ablation of both atrial ventricular nodal reentrant and atrial ventricular reentrant tachycardia in a single session. Clin Cardiol 1994;17:337-339. 4. Sticherling C, Tada H, Greenstein R, et al. Incidence and clinical significance of inducible atrial tachycardia in patients with atrioventricular nodal reentrant tachycardia. J Cardiovasc Electrophysiol 2001;12:507-510. 5. Yamada T, Okamoto M, Sueda T, Hashimoto M, Nomura K, Kajiyama G. Radiofrequency catheter ablation for a patient with Wolf-Parkinsin-White syndrome associated with sustained atrial tachycardia. Intern med 1996;35:791-794. 6. Iturralde P, Guevara-Valdivia M, Rodriguez-Chavez L, Medeiros A, Colin L. Radiofrequency ablation of multiple accessory pathways. Europace 2002;4:273-280. 7. Gallagher JJ, Pritchett ELC, Sealy WC, et al. the preexcitation syndromes. Frog Cardiovasc Dis 1978;20:285. 8. Gallagher JJ, Sealy WC, Kassell J, Wallace AG. Multiple accessory pathways in patients with the preexcitation syndrome. Circulation 1976;54:571-591. 9. Josephson ME. Preexcitation syndromes. In: Josephson ME, eds. Clinical cardiac electrophysiology: Technique and interpretations, 3rd ed. Philadelphia: Lippincott Williams and Wilkins 2002:386. 10. Zardini M, Leitch JW, Guairaudon GM, Klein GJ, Yeer R. Atrioventricular nodal reentry and dual atrioventricular node physiology in patients undergoing accessory pathway ablation. Am J Cardiol 1990;66:1388-1389. 11. Pritchet ELC, Prystowsky EN, Benditt DG, Gallagher JJ. Dual atrioventricular nodal pathways in patients with Wolf-Parkinson-White syndrome. Br Heart J 1980;43:7-13. 12. Csanadi Z, Klein GJ, Yee R, Thakur RK, Li H. Effects of dual atrioventricular node pathways on atrioventricular reentrant tachycardia. Circulation 1995;91:2614-2618. 13. Vora A, Lokhandwala Y. Adulterous Tachycardia: What Is the Mechanism? PACE 1998;21:1146-7. citation: Haghjoo, Majid and Arya, Arash and Dehghani, Mohammadreza and Emkanjoo, Zahra and Fazelifar, Amirfarjam and Sadr-Ameli, MohammadAli (2005) Multiple Arrhythmogenic Substrate for Tachycardia in a Patient with Frequent Palpitations. [Journal (Paginated)] document_url: http://cogprints.org/4176/1/haghjoo.pdf