Surgical Division of Right and Left Free Wall Accessory Atrioventricular Electrical Connections in a Child with Incessant Supraventricular Tachycardia

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Abstract
A child with Wolff-Parkinson-White syndrome developed incessant supraventricular tachycardia refractory to medical therapy and countershocks. Supraventricular tachycardias incorporating both right and left free wall accessory atrioventricular electrical connections were demonstrated. The more frequent, broad complex tachycardia used both accessory connections and was independent of the atrioventricular node. The less frequent, narrow complex tachycardia used the atrioventricular node for anterograde conduction and the left sided accessory connection for retrograde conduction. Surgical division of the accessory connections restored normal sinus rhythm and eliminated supraventricular tachycardia.