EMERGENCE OF BIDIRECTIONAL ACCESSORY PATHWAY CONDUCTION IN ADULTHOOD

Emergence of AP Conduction in Adulthood. A 30-year-old woman presented with tachycardiomyopathy due to atrial flutter-fibrillation and under went radiofrequency ablation of the AV node and VVIR pacemaker implant ation, There was no evidence of any accessory pathway (AP) conduction during the AV nodal ablation or during chronic ventricular pacing. One year later, she had a transient preexcited tachycardia, A year after this, her ECG showed 1:1 AV conduction with preexcitation. Electrophys iologic study revealed a left lateral AP with anterograde and retrogra de refractory periods of 280 and 240 msec, respectively. Successful ra diofrequency ablation of the AP was performed. This case highlights a unique emergence of an AP in adult life.