Slow pathway modification for treatment of pseudo-pacemaker syndrome due to first-degree atrioventricular block with dual atrioventricular nodal physiology
Year: 2017
Type: article
Study design: Case Report
Abstract: Key Teaching Points•Marked first-degree atrioventricular (AV) block is a well-recognized cause of the pseudo-pacemaker syndrome, whereby atrial systole in close proximity to the preceding ventricular systole leads to various hemodynamic changes, including systemic hypotension, elevated pulmonary arterial pressures, and cannon A-waves. In instances of dual AV nodal physiology, preferential slow pathway conduction can present in a similar fashion.•Literature regarding the treatment of this rare condition has been limited to dual-chamber pacing to restore a typical AV mechanical relationship.•A potential concern for performing slow pathway modification in patients with pseudo-pacemaker syndrome due to preferential slow pathway conduction is inadequate residual fast pathway conduction.•Electrotonic coupling between fast and slow pathway has been demonstrated, with complete ablation of the slow pathway associated with shortening of fast pathway effective refractory period.•We describe a case of pseudo-pacemaker syndrome due to preferential slow pathway conduction that was successfully treated with slow pathway ablation. This was associated with improvements in fast pathway Wenkebach cycle length and PR interval (at rest and with exertion). The latter finding remains robust and the patient remains asymptomatic after 9 months of follow-up. •Marked first-degree atrioventricular (AV) block is a well-recognized cause of the pseudo-pacemaker syndrome, whereby atrial systole in close proximity to the preceding ventricular systole leads to various hemodynamic changes, including systemic hypotension, elevated pulmonary arterial pressures, and cannon A-waves. In instances of dual AV nodal physiology, preferential slow pathway conduction can present in a similar fashion.•Literature regarding the treatment of this rare condition has been limited to dual-chamber pacing to restore a typical AV mechanical relationship.•A potential concern for performing slow pathway modification in patients with pseudo-pacemaker syndrome due to preferential slow pathway conduction is inadequate residual fast pathway conduction.•Electrotonic coupling between fast and slow pathway has been demonstrated, with complete ablation of the slow pathway associated with shortening of fast pathway effective refractory period.•We describe a case of pseudo-pacemaker syndrome due to preferential slow pathway conduction that was successfully treated with slow pathway ablation. This was associated with improvements in fast pathway Wenkebach cycle length and PR interval (at rest and with exertion). The latter finding remains robust and the patient remains asymptomatic after 9 months of follow-up.
Source: HeartRhythm Case Reports
Institution: New York University
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,100
OpenAlex ID: W2779284470