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Characteristics of antegrade-only accessory pathways in children and adolescents

Part of: Electrophysiology

Published online by Cambridge University Press:  25 January 2021

Minh B. Nguyen Open the ORCID record for Minh B. Nguyen [Opens in a new window] ,
Allison C. Hill ,
Yaniv Bar-Cohen  and
Michael J. Silka
Minh B. Nguyen*
Affiliation:
The Division of Cardiology, Department of Pediatrics, Children’s Hospital Los Angeles, Toronto, ON, Canada
Allison C. Hill
Affiliation:
The Division of Cardiology, Department of Pediatrics, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
Yaniv Bar-Cohen
Affiliation:
The Division of Cardiology, Department of Pediatrics, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
Michael J. Silka
Affiliation:
The Division of Cardiology, Department of Pediatrics, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
*
Author for correspondence: Dr M. B. Nguyen, MD, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ONM5G 1X8, Canada. Tel: 416-813-5848; Fax: 416-813-5582. E-mail: minh.nguyen@sickkids.ca
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Abstract

There is minimal data regarding antegrade-only accessory pathways in young patients. Given evolving recommendations and treatments, retrospective analysis of the clinical and electrophysiologic properties of antegrade-only pathways in patients <21 years old was performed, with subsequent comparison of electrophysiology properties to age-matched controls with bidirectional pathways. Of 522 consecutive young patients with ventricular pre-excitation referred for electrophysiology study, 33 (6.3%) had antegrade-only accessory pathways. Indications included palpitations (47%), chest pain (25%), and syncope (22%). The shortest value for either the accessory pathway effective refractory period or the pre-excited R-R interval was taken for each patient, with the median of the antegrade-only group significantly greater than shortest values for the bidirectional group (310 [280–360] ms versus 270 [240–302] ms, p < 0.001). However, the prevalence of pathways with high-risk properties (effective refractory period or shortest pre-excited R-R interval <250 ms) was similar in both study patients and controls (13% versus 21%) (p = 0.55). Sixteen patients had a single antegrade-only accessory pathway and no inducible arrhythmia. Six patients had Mahaim fibres, all right anterolateral with inducible antidromic reciprocating tachycardia. However, 11 patients with antegrade-only accessory pathways and 3 with Mahaim fibres had inducible tachycardia due to a second substrate recognised at electrophysiology study. These included concealed accessory pathways (7), bidirectional accessory pathways (5), and atrioventricular node re-entry (2). Antegrade-only accessory pathways require comprehensive electrophysiology evaluation as confounding factors such as high-risk conduction properties or inducible Supraventricular Tachycardia (SVT) due to a second substrate of tachycardia are often present.

Keywords

Paediatric cardiologyelectrophysiologyablationventricular pre-excitation
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 8 , August 2021 , pp. 1258 - 1262
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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