{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T08:31:54Z","timestamp":1789201914517,"version":"build-2803163510"},"reference-count":14,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,2,23]],"date-time":"2018-02-23T00:00:00Z","timestamp":1519344000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Concealed left\u2010sided accessory pathways (CLAP) are a cause of supraventricular tachycardia (SVT) in the young. Most are mapped with right ventricular (RV) apical\/outflow pacing. Rarely, alternative means of mapping are required. We review our experience from three pediatric electrophysiology (EP) centers with a rare form of \u201chidden\u201d CLAP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All patients\u00a0&lt;21 years undergoing EP study from 2008 to 2014 with a \u201chidden\u201d CLAP (defined as an accessory pathway [AP] for which RV pacing at cycle lengths [CL] stable for mapping did not demonstrate eccentric retrograde conduction) were included. Exclusion criteria: preexcitation. Demographic, procedural, and follow\u2010up data were collected.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 23 patients met the criteria (median age, 14.3 years [range 7\u201321], weight, 51\u00a0kg [31\u201399]). 21 (96%) had SVT and one AFIB (4%). APs were adenosine sensitive in 7\/20 patients (35%) and VA conduction was decremental in six (26%). CLAP conduction was demonstrable with orthodromic reentrant tachycardia in all patients, with RV extrastimulus testing in seven (30%) and with rapid RV pacing (&lt;CL 300) in three (13%). Left ventricular (LV) pacing demonstrated CLAP conduction in 17\/17 (100%) patients in whom it was used. All 23 CLAPs were successfully ablated (100%) via transseptal approach with radiofrequency energy. Specific ablation techniques included: 16 (70%) during LV paced rhythm, four (17%) during orthodromic reciprocating tachycardia (ORT; 3\/4 ventricular entrained), and three (13%) with brief rapid RV pacing. There were no complications. At 18 months (range 3\u201396), there was one recurrence (4%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Some CLAPs are only demonstrable with LV pacing, entrained ORT, or rapid RV pacing. LV pacing facilitated preferential AP conduction, allowing for mapping while maintaining stable hemodynamics.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pace.13279","type":"journal-article","created":{"date-parts":[[2018,1,12]],"date-time":"2018-01-12T05:52:40Z","timestamp":1515736360000},"page":"368-371","source":"Crossref","is-referenced-by-count":5,"title":["The \u201chidden\u201d concealed left\u2010sided accessory pathway: An uncommon cause of SVT in young people"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8030-3367","authenticated-orcid":false,"given":"Robert H.","family":"Pass","sequence":"first","affiliation":[{"name":"The Children's Hospital at Montefiore, Albert Einstein College of Medicine Yeshiva University  Bronx NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Liberman","sequence":"additional","affiliation":[{"name":"New York Presbyterian Hospital, Children's Hospital of NY Columbia University College of Physicians and Surgeons  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric S.","family":"Silver","sequence":"additional","affiliation":[{"name":"New York Presbyterian Hospital, Children's Hospital of NY Columbia University College of Physicians and Surgeons  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher M.","family":"Janson","sequence":"additional","affiliation":[{"name":"The Children's Hospital at Montefiore, Albert Einstein College of Medicine Yeshiva University  Bronx NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew D.","family":"Blaufox","sequence":"additional","affiliation":[{"name":"Cohen's Children's Hospital Hofstra\u2010Northwell School of Medicine  New Hyde Park NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn","family":"Nappo","sequence":"additional","affiliation":[{"name":"The Children's Hospital at Montefiore, Albert Einstein College of Medicine Yeshiva University  Bronx NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott R.","family":"Ceresnak","sequence":"additional","affiliation":[{"name":"Lucile Packard Children's Hospital Stanford University  Palo Alto CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,2,23]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"95","volume-title":"Cardiac Arrhythmias in Children and Young Adults with Congenital Heart Disease","author":"Walsh EP","year":"2001"},{"key":"e_1_2_7_3_1","volume-title":"Pediatric Arrhythmias Electrophysiology and Pacing","author":"Gillette PC","year":"1990"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1460-9592.2002.01000.x"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1058-9813(01)00083-2"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001573-200401000-00013"},{"key":"e_1_2_7_7_1","first-page":"652","article-title":"Guidelines for clinical intracardiac electrophysiological and catheter ablation procedures. 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