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Peer-reviewedCC BY 4.0Frontiers in Cardiovascular Medicine

Case Report: Isoproterenol-dependent concealed right anteroseptal accessory pathway

  • Tianxiao Wang1
  • Xinhua Zheng2
  1. 1Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of People's Liberation Army of China
  2. 2Department of Ophthalmology, Affiliated Children's Hospital of Jiangnan University (Wuxi Children's Hospital)
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Abstract

A 34-year-old male with no history of chronic medical illness or regular medication use presented with recurrent palpitations, chest tightness, and presyncope over two weeks. A wearable smart device recorded brief runs of irregular narrow-complex tachycardia, which were initially misdiagnosed as paroxysmal atrial fibrillation. During baseline electrophysiological study (EPS), ventriculoatrial (VA) conduction exhibited Wenckebach periodicity; no accessory pathway (AP) was identified, and no supraventricular tachycardia (SVT) could be induced. Following intravenous isoproterenol (ISO) infusion, retrograde conduction improved, and narrow-complex tachycardia was successfully induced via programmed stimulation [S1S2 coupling intervals of 330/210 milliseconds (ms)] from the coronary sinus. Orthodromic atrioventricular reentrant tachycardia (AVRT) was confirmed. The concealed AP was localized to the right anteroseptal region (specifically, the 12–1 o'clock position on the tricuspid annulus) and was successfully ablated using radiofrequency energy. Post-ablation EPS demonstrated non-inducibility of tachycardia. The patient remained free of arrhythmia recurrence during 18 months of clinical follow-up. This case illustrates a rare isoproterenol-dependent concealed right anteroseptal AP and underscores the diagnostic utility of ISO provocation in patients with narrow-complex tachycardia when arrhythmia is not induced on standard EPS.

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Cite

BibTeXRIS
BibTeX
@article{wang2026case,
  title = {{Case Report: Isoproterenol-dependent concealed right anteroseptal accessory pathway}},
  author = {Tianxiao Wang and Xinhua Zheng},
  journal = {Frontiers in Cardiovascular Medicine},
  year = {2026},
  month = nov,
  doi = {10.3389/fcvm.2026.1925026},
  url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1925026/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Case Report: Isoproterenol-dependent concealed right anteroseptal accessory pathway
AU  - Tianxiao Wang
AU  - Xinhua Zheng
PY  - 2026
DA  - 2026/11/05
JO  - Frontiers in Cardiovascular Medicine
DO  - 10.3389/fcvm.2026.1925026
UR  - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1925026/full
AB  - A 34-year-old male with no history of chronic medical illness or regular medication use presented with recurrent palpitations, chest tightness, and presyncope over two weeks. A wearable smart device recorded brief runs of irregular narrow-complex tachycardia, which were initially misdiagnosed as paroxysmal atrial fibrillation. During baseline electrophysiological study (EPS), ventriculoatrial (VA) conduction exhibited Wenckebach periodicity; no accessory pathway (AP) was identified, and no supraventricular tachycardia (SVT) could be induced. Following intravenous isoproterenol (ISO) infusion, retrograde conduction improved, and narrow-complex tachycardia was successfully induced via programmed stimulation [S1S2 coupling intervals of 330/210 milliseconds (ms)] from the coronary sinus. Orthodromic atrioventricular reentrant tachycardia (AVRT) was confirmed. The concealed AP was localized to the right anteroseptal region (specifically, the 12–1 o'clock position on the tricuspid annulus) and was successfully ablated using radiofrequency energy. Post-ablation EPS demonstrated non-inducibility of tachycardia. The patient remained free of arrhythmia recurrence during 18 months of clinical follow-up. This case illustrates a rare isoproterenol-dependent concealed right anteroseptal AP and underscores the diagnostic utility of ISO provocation in patients with narrow-complex tachycardia when arrhythmia is not induced on standard EPS.
SN  - 2297-055X
ER  -