Int J Arrhythm.  2017 Mar;18(1):38-42. 10.18501/arrhythmia.2017.005.

Supraventricular Tachycardia by Concealed Bypass Tract

• Lee KH

• KMID: 2377065
• DOI: http://doi.org/10.18501/arrhythmia.2017.005

Abstract

Concealed bypass tract (CBT) results from incomplete development of the atrioventricular (AV) annulus. CBT conducts only in a retrograde direction, and therefore does not cause pre-excitation on standard electrocardiograms. The most common tachycardia associated with CBT is an orthodromic atrioventricular reentrant tachycardia (AVRT): a pathway involving anterograde circuitry through the AV node and His Purkinje system and retrograde conduction over the accessory pathway. Orthodromic AVRT accounts for approximately 90%-95% cases of AVRT. Most incidences of CBT occur at the left free wall. Vagal maneuvers and/or intravenous (IV) adenosine are recommended for first line acute management of AVRT. However, pharmacological therapy with IV diltiazem, verapamil, or beta blockers can also be effective for acute treatment for orthodromic AVRT in patients who do not show pre-excitation on their resting ECG during sinus rhythm. The first-line ongoing therapy for AVRT is catheter ablation of CBT; when catheter ablation is not indicated or preferred, oral beta blockers, diltiazem, verapamil, flecainide, propafenone, or amiodarone are recommended.

Keyword

Supraventricular Tachycardia; AVNRT

MeSH Terms

Adenosine
Amiodarone
Atrioventricular Node
Catheter Ablation
Diltiazem
Electrocardiography
Flecainide
Humans
Incidence
Propafenone
Tachycardia
Tachycardia, Supraventricular*
Verapamil
Adenosine
Amiodarone
Diltiazem
Flecainide
Propafenone
Verapamil