Author/Authors :
Kamali, Farzad Department of Cardiac Electrophysiology - Rajaie Cardiovascular Medical and Research Center - Iran University of Medical Sciences, Tehran, Iran , Khorgami, Mohammadrafie Cardiac Electrophysiology Research Center - Rajaie Cardiovascular Medical and Research Center - Iran University of Medical Sciences, Tehran, Iran , Faridi, Bayan School of Medicine - Kermanshah University of Medical Sciences, Kermanshah, Iran , Soleimani, Abbas Rajaie Cardiovascular Medical and Research Center - Iran University of Medical Sciences, Tehran, Iran
Abstract :
Radiofrequency ablation of concealed posteroseptal accessory pathway (AP) and differentiating the right posteroseptal from the left is a
challenge for electrophysiologists. Considering different electrophysiological characteristics of posteroseptal AP can help to predict the
successful ablation site. We report on a 45‑year‑old man with simultaneous orthodromic reentrant tachycardia and atrioventricular nodal
reentrant tachycardia, both of which were successfully ablated in the right posteroseptal area at the site of the slow pathway. The arrhythmia
with both right bundle branch block (RBBB) and left bundle branch block (LBBB) aberrant conduction was observed during our study. The
ventriculoatrial (VA) interval increased approximately 25 ms when arrhythmia was conducted with LBBB aberrancy, while it did not change
during the RBBB aberrancy. This finding is diagnostic for orthodromic reciprocating tachycardia using a left‑sided AP rather than right.
However, other parameters, such as delta VA interval and sharp/blunt feature in the proximal coronary sinus electrogram, indicated that the
AP is located on the right posteroseptal area.
