Atrio-ventricular reentry tachycardia, without involvement of the AV node – dual accesory pathway in young, otherwise healthy patient
█ Case report
Piros Katalin, Nagy Klaudia Vivien, Szegedi Nándor, Osztheimer István, Salló Zoltán, Perge Péter, Herczeg Szilvia, Merkely Béla, Gellér László
Semmelweis Egyetem, Városmajori Szív- és Érgyógyászati Klinika, Budapest
Introduction: The prevalence of WPW syndrome in normal population is 0.15-0.25%. Among patients with Ebstein anomaly the presence of multiple accessory pathways (AP) is more frequent (52%), while among patients with structurally normal heart it occurs rarely (13%). In symptomatic WPW syndrome the gold standard treatment is catheter ablation .
Case presentation: 41 year-old male patient was admitted to our clinic without history of any known diseases. Three months before admission, the patient was presented with regular, narrow QRS tachycardia, which was terminated with i.v. adenosine. Two weeks before the present admission, wide QRS tachycardia evolved, electrical cardioversion was performed. Transthoracic echocardiography showed preserved left ventricular ejection fraction (LVEF: 60%), without any valve disease or wall motiont abnormality. On resting ECG delta wave was present with very short PR interval. Electrophysiological study was performed, which revealed rigth and left AP-s with orthodromic AVRT involving the right AP and antidromic AVRT involving both AP-s. Successful radiofrequency catheter ablations of both AP-s were performed without any complications. Since the ablation no arrhytmias occured.
Discussion: Rarely, multiple accessory pathways may be present in patients without any structural heart disease, which can be treated simultaneously with catheter ablation during the same procedure.