Clinical Characteristics of Antidromic Atrioventricular Reentrant Tachycardia in Children

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Background: Atrioventricular reentrant tachycardia (AVRT) is the most common tachyarrhythmia in children, but the occurrence of antidromic AVRT is very rare. Methods: From 1995 to 2011, 134 patients (163 sessions) underwent electrophysiological study (EPS) for AVRT less than 20 years. Between them, there were only 3 patients with antidromic AVRT. Result: Case 1: Nine year-old-boy had been diagnosed Ebsteins anomaly and WPW syndrome at newborn period. There were 3 accessary pathways (APs) at right posterior, anterolateral and lateral wall. AVRT was induced in AP as antegrade conduction, and retrograde atrioventricular-node (AVN) conduction. Case 2: Eleven year-old-boy was diagnosed as WPW syndrome. AVRT was induced via antegrade left anterior AP and retrograde AVN conduction. Case 3: Fifteen year-old-girl was diagnosed as WPW syndrome and we performed successful right postero-paraseptal AP ablation at 7 year-old. Seven years later, she had recurrence of tachycardia, with antidromic AVRT via right postero-paraseptal AP in antegrade rim and AVN in retrograde rim. Antegrade AP effective refractory period (ERP) in these 3 patients were longer than AVNERP. Conclusion: The incidence of antidromic AVRT was reported to be about 5% in all AVRT, but 2.2% of AVRT in this study. AVNERP in children is usually shorter than adult, that may result in rare occurrence of antidromic AVRT in children.