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Mechanical Ablation of Concealed Left Lateral Bypass Tract

Division of Cardiology, VA Medical Center of West Los Angeles

Robin Wachsner, MD

Division of Cardiology, Olive View-UCLA Medical Center, and the UCLA School of Medicine, Los Angeles, California

Donna Gallik, MD

Division of Cardiology, VA Medical Center of West Los Angeles

A 50-year-old man with hypertension had been treated for supraventricular tachycardia with several medications for nine years. In 1990, he was started on amiodarone but a year later he developed side effects causing discontinuation of amiodarone. Because of his recurrent episodes of palpitations associated with near syncope, chest pain and shortness of breath, he underwent an electrophysiology study in 1992 that showed orthodromic AVRT with the pres ence of a concealed left-sided accessory bypass tract. Scheduled for radiofrequency ablation the following day, after catheters were placed and during mapping of the lateralmitral annu lus, his tachycardia stopped abruptly without further inducability. Isoproterenol infusion dur ing atrial and ventricular stimulation also failed to induce his original tachycardia. A year later, the patient presented with palpitations that felt different than his previous experiences. Work-up at that point only revealed a parasystolic focus on a 24-hour ECG monitoring with out any form of supraventricular tachycardia. This represents a very unusual case by which the left lateral accessory pathway was mechanically ablated with catheter manipulation. This led to the disappearance of the orthodromic tachycardia that was easily induced before due to the activity of his parasytolic focus. The latter continued for the following four years but the patient has had no recurrences of his tachycardia.

Key Words: ablation • orthodromic tachycardia • concealed accessory bypass tract

Journal of Cardiovascular Pharmacology and Therapeutics, Vol. 2, No. 3, 223-227 (1997)
DOI: 10.1177/107424849700200309


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