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Cited by 91Cardiac Arrhythmias and TreatmentsCardiac electrophysiology and arrhythmiasCardiac pacing and defibrillation studies

Variants of Preexcitation—Specialized Atriofascicular Pathways, Nodofascicular Pathways, and Fasciculoventricuiar Pathways: Electrophysiologic Findings and Target Sites for Radiofrequency Catheter Ablation

KOTTKAMP, HANS, HINDRICKS, GERHARD, SHENASA, HOSSEIN, CHEN, XU, WICHTER, THOMAS, BORGGREFE, MARTIN, BREITHARDT, GUNTER·1996·Journal of Cardiovascular Electrophysiology
DOI 10.1111/j.1540-8167.1996.tb00466.x
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Abstract

INTRODUCTION: In the present report, the electrophysiologic findings in patients with different types of variants of preexcitation, i.e., atriofascicular, nodofascicular, and fasciculoventricular fibers, and the results of radiofrequency catheter ablation using different target sites are described. METHODS AND RESULTS: Twelve patients (mean age 36 +/- 17 years) with variants of the preexcitation syndromes underwent electrophysiologic study and radiofrequency catheter ablation. The atrial origin of atriofascicular pathways remote from the normal AV node was assessed by application of late atrial extrastimuli that advanced ("reset") the timing of the next QRS complex without anterograde penetration into the AV node. In patients with atriofascicular pathways, ablation of the accessory pathway or the retrograde fast AV node pathway was attempted. Ablation of the atriofascicular pathways was guided by a stimulus-delta wave interval mapping in the first five patients and by recording of atriofascicular pathway activation potentials in the next five patients. A nodofascicular pathway was suggested if VA dissociation occurred during tachycardia and if atrial extrastimuli failed to reset the tachycardia without anterograde penetration into the AV node. A fasciculoventricular connection was suggested if the proximal insertion of the accessory pathway was found to arise from the His bundle or bundle branches. The PR interval was expected within normal limits during sinus rhythm and the QRS complex to be slightly prolonged with a discrete slurring of the R wave, suggesting a small delta wave. Ten of the 12 patients had evidence for atriofascicular pathways and one patient each for a nodofascicular and fasciculoventricular pathway. In six patients, the atriofascicular pathways were successfully ablated, and in two patients, the retrograde fast AV node pathway. In one patient, a concealed right posteroseptal accessory AV pathway served as the retrograde limb and was successfully ablated. The nodofascicular pathway was shown to be a bystander during AV node reentrant tachycardia. After successful fast AV node pathway ablation resulting in marked PR prolongation, no preexcitation was present during sinus rhythm because of the proximal insertion of the nodofascicular pathway distal to the delay producing parts of the AV node. The proximal insertion of the fasciculoventricular pathway was suggested to arise distal to the AV node at the site of the penetrating AV bundle. The earliest ventricular activation at the His-bundle recording site indicated the ventricular insertion of this accessory connection into the ventricular summit. The fasciculoventricular connection gave rise to a fixed ventricular preexcitation and served as a bystander during orthodromic AV reentrant tachycardia incorporating a left-sided accessory AV pathway. CONCLUSION: The majority of patients with variants of the preexcitation syndrome present with specialized atriofascicular pathways that seem to originate from remnants of the specialized AV ring tissue. Nodofascicular and fasciculoventricular pathways exist and may give rise to preexcitation, although their functional role in participation of clinical arrhythmias still needs to be elucidated. In the present study, both a fasciculoventricular pathway and a nodofascicular pathway acted as a bystander.

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Crossref · 10.1111/j.1540-8167.1996.tb00466.x

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Authors
KOTTKAMP, H., HINDRICKS, G., SHENASA, H., CHEN, X., WICHTER, T., BORGGREFE, M., & BREITHARDT, G.
Affiliations
University of Münster (DE)
Corresponding author
KOTTKAMP, HANS
ORCID
Venue
Journal of Cardiovascular Electrophysiology
Publisher
Wiley
Published
1996-10
Volume
7
Issue
10
Pages
916-930
ISSN
  • 1045-3873 (ISSN-L)
  • 1540-8167
DOI
10.1111/j.1540-8167.1996.tb00466.x
OpenAlex
W1484639582
Cited by
91
References
26
Citations by year
2024: 3 · 2022: 5 · 2021: 2 · 2020: 6 · 2019: 9 · 2017: 2 · 2016: 2 · 2015: 2 · 2014: 3 · 2013: 3 · 2012: 3
FWCI
0.87
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 3862 d)
Locations
  • Journal of Cardiovascular Electrophysiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Keywords
preexcitation syndrome, atriofascicular pathway, accessory pathway, radiofrequency catheter ablation, atrioventricular nodal reentrant tachycardia, atrioventricular block, His bundle, bundle branches, delta oscillations, PR interval
MeSH terms
Adolescent, Adult, Aged, Atrioventricular Node, Electrocardiography, Female, Follow-Up Studies, Humans, Male, Middle Aged, Tachycardia, Atrioventricular Nodal Reentry, Catheter Ablation

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