Premature Atrial Contractions Managed With Slow Pathway Ablation

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Premature Atrial Contractions Managed With Slow Pathway Ablation

We present data from 18 year old male patient referred to our clinic for evaluation and treatment due to persistent premature atrial contractions (PAC). Up to the time of admission, the patient never experienced paroxysmal tachycardia, and his principal complaint was the irregular heart rhythm refractory to all types of antiarrhytmic drug therapy. Electrophysiological study was performed and it revealed that continuous pacing in the right ventricle produced a retrograde conduction block at rates 500 msec. Decremental programmed electrical stimulation in the right atrium (S1S2 540/340 to 540/330 ms induced a sudden prolongation of A - H interval (AH jump of 98 ms) and a nonreentrant tachycardia (cycle length = 492 ms). Intracardiac electrogram showed that supraventricular activity emerged from simultaneous conduction over the slow and fast pathways of the atrioventricular node. This type of conduction is usually seen in patients with atrioventricular nodal reentry tachycardia, but our patient never previously complained of tachycardia, and the electrogram during tachycardia was not suggestive for atrioventricular nodal reentry tachycardia. Subsequent ablation of the slow pathway at the base of the Koch triangle yielded a cessation of the supraventricular premature activity, absence of the nonreentrant tachycardia and disappearance of the A-H jump.

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