Author + information
- Received April 20, 2018
- Accepted May 31, 2018
- Published online July 25, 2018.
- Edward P. Walsh, MD∗ ()
- Cardiac Electrophysiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Edward P. Walsh, Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115.
Ebstein’s anomaly of the tricuspid valve is a relatively rare form of congenital heart disease that has long been a challenge to electrophysiologists and cardiac surgeons. In addition to the hemodynamic burden of the actual valve defect, Ebstein’s patients must also contend with an extraordinarily high incidence of tachyarrhythmias, most of which can be attributed to accessory atrioventricular pathways (APs) located along the posterior and septal border of the tricuspid valve where the valve leaflets are most abnormal. It is the only congenital heart defect with such a dramatic predisposition toward APs. Although it is logical to postulate a link between the anatomic deformity and the conduction abnormality, the exact nature of this link is still not fully understood and remains a fertile area for investigation that might shed light on abnormal conduction pathways in many other forms of heart disease. Furthermore, for reasons that are only now being fully appreciated, successful catheter ablation of APs in this setting is frequently more challenging than would be expected in a structurally normal heart. This review will explore the gross and microscopic anatomy of Ebstein’s anomaly with attention to features that could be important to both arrhythmogenesis and ablation therapy in this unique population.
- accessory pathways
- catheter ablation
- cone operation
- congenital heart disease
- pediatric cardiology
- supraventricular tachycardia
- ventricular tachycardia
- Wolff-Parkinson-White syndrome
Dr. Walsh is supported in part by the Sean Roy Johnson Memorial Fund for electrophysiology research at Boston Children’s Hospital and the Lawrence J. Sloss chair in cardiology at Boston Children’s Hospital.
The author attests he is in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received April 20, 2018.
- Accepted May 31, 2018.
- 2018 American College of Cardiology Foundation
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