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Hein J J Wellens - One of the best experts on this subject based on the ideXlab platform.

  • An unusual ectopic ventricular rhythm in a young woman.
    Journal of cardiovascular electrophysiology, 2019
    Co-Authors: Eduardo Back Sternick, Yash Lokhandwala, Hein J J Wellens
    Abstract:

    A case of a 22-year-old young pregnant woman with palpitations and near syncope is presented. Holter monitoring showed very frequent premature beats and runs of wide complex tachycardia, refractory to antiarrhythmic drugs. Electrophysiologic evaluation disclosed spontaneous automatism arising in an Atriofascicular Pathway. Differential diagnosis is discussed.

  • atypical bypass tracts can they be recognized during sinus rhythm
    Europace, 2019
    Co-Authors: Jose Nunes De Alencar Neto, Saulo Rodrigo Ramalho De Moraes, Eduardo Back Sternick, Hein J J Wellens
    Abstract:

    Atypical bypass tracts or variants of ventricular pre-excitation are rare anatomic structures often with rate-dependent slowing in conduction, called decremental conduction. During sinus rhythm, electrocardiographic recognition of those structures may be difficult because unlike in the Wolff-Parkinson-White syndrome where usually overt ventricular pre-excitation is present, the electrocardiogram (ECG) often shows a subtle pre-excitation pattern because of less contribution to ventricular activation over the slow and decrementally conducting bypass. Following the structure described by Ivan Mahaim and Benatt corresponding to a fasciculoventricular Pathway, several other new variants of ventricular pre-excitation were reported. In this review, we aim to discuss the electrocardiographic pattern of the different subtypes of variants of ventricular pre-excitation, including the Atriofascicular Pathway, long and short decrementally conducting atrioventricular Pathways, fasciculoventricular Pathway, the atrio-Hisian bypass tract, and nodoventricular and nodofascicular fibres. Emphasis will be on the ECG findings during sinus rhythm.

  • atypical bypass tracts can they be recognized during sinus rhythm
    Europace, 2019
    Co-Authors: Jose Nunes De Alencar Neto, Saulo Rodrigo Ramalho De Moraes, Eduardo Back Sternick, Hein J J Wellens
    Abstract:

    Atypical bypass tracts or variants of ventricular pre-excitation are rare anatomic structures often with rate-dependent slowing in conduction, called decremental conduction. During sinus rhythm, electrocardiographic recognition of those structures may be difficult because unlike in the Wolff-Parkinson-White syndrome where usually overt ventricular pre-excitation is present, the electrocardiogram (ECG) often shows a subtle pre-excitation pattern because of less contribution to ventricular activation over the slow and decrementally conducting bypass. Following the structure described by Ivan Mahaim and Benatt corresponding to a fasciculoventricular Pathway, several other new variants of ventricular pre-excitation were reported. In this review, we aim to discuss the electrocardiographic pattern of the different subtypes of variants of ventricular pre-excitation, including the Atriofascicular Pathway, long and short decrementally conducting atrioventricular Pathways, fasciculoventricular Pathway, the atrio-Hisian bypass tract, and nodoventricular and nodofascicular fibres. Emphasis will be on the ECG findings during sinus rhythm.

  • Atrial Premature Beats During Decrementally Conducting Antidromic Tachycardia
    Circulation. Arrhythmia and electrophysiology, 2013
    Co-Authors: Eduardo Back Sternick, Yash Lokhandwala, Carl Timmermans, Luiz Márcio Gerken, Frederico Soares, Liana Valadao Dias, Yan Huo, Gerhard Hindricks, Hein J J Wellens
    Abstract:

    Background— Advancement of ventricular activation by an atrial premature beat (APB) given during His bundle refractoriness followed by resetting of an antidromic tachycardia (AT) in patients with decrementally conducting accessory Pathway (DAP) is a helpful maneuver to prove Pathway existence and participation in the circuit. We aim to assess in a large cohort the role of APB during AT in patients with a DAP. Methods and Results— Thirty-three patients with a DAP having 34 AT were included in the study: 29 patients had an Atriofascicular Pathway, 1 had a long atrioventricular DAP, and 4 had a short atrioventricular fiber. APBs were delivered initially from the lateral right atrium, scanning diastole with a 10-ms decrement until AT termination or refractoriness. We observed 4 patterns of response after APB during AT: advancement of activation (29 cases), delay (2), advancement followed by delay (3), and termination (7). Eight patients required an earlier APB to advance or delay ventricular activation. These 8 patients had a shorter AT cycle length (median of 273 versus 315 ms; P =0.003) and had a shorter resetting zone (median coupling interval of 30 versus 50 ms; P =0.01). Conclusions— APB delivered during AT in patients with a DAP advanced and/or delayed ventricular activation in all patients. In 1 of 5 of cases the AT was terminated by a single APB. In approximately a quarter of the patients an earlier coupled APB was needed to reset AT. The high RA was an adequate stimulation site in all right-sided DAP.

  • The atrioventricular interval during pre-excited tachycardia: a simple way to distinguish between decrementally or rapidly conducting accessory Pathways.
    Heart rhythm, 2009
    Co-Authors: Eduardo Back Sternick, Yash Lokhandwala, Carl Timmermans, Luz Maria Rodriguez, Luiz Márcio Gerken, Ricardo Baeta Scarpelli, Frederico Soares, Hein J J Wellens
    Abstract:

    Background Recognition of the presence and role of decremental fibers during wide QRS tachycardia requires carefully executed intracardiac studies. Objective This study sought to determine the value of the atrioventricular (AV) conduction time during pre-excited tachycardia to differentiate a fast from a decrementally conducting accessory Pathway (AP). Methods Fifty-one patients with 56 pre-excited tachycardias were included in the study: Group I: 27 patients with 31 antidromic tachycardia (ADT) using an Atriofascicular Pathway, Group II: 2 patients with pre-excited tachycardia due to bystander AV conduction, Group III: 3 patients with ADT and a short AV Mahaim fiber, and Group IV: 19 patients with 21 ADT using a fast conducting right-sided AP. The AV interval was measured in the His bundle electrogram and related to the tachycardia cycle length (TCL) by making an AV/TCL index. Results An AV interval ≥ 150 ms during pre-excited tachycardia yielded a 91% sensitivity, 90% specificity, positive predictive value of 94%, and negative predictive value of 83% for AV conduction over a decrementally conducting Pathway, whereas a ≥0.55 AV/TCL index yielded a sensitivity of 89%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 84%. In 3 of 4 patients with Mahaim fibers and a Conclusions An AV interval ≥150 ms during pre-excited tachycardia is a fast and reliable method for detecting a decrementally conducting AP. Correcting the AV interval by the tachycardia cycle length improved specificity and positive predictive accuracy.

Eduardo Back Sternick - One of the best experts on this subject based on the ideXlab platform.

  • An unusual ectopic ventricular rhythm in a young woman.
    Journal of cardiovascular electrophysiology, 2019
    Co-Authors: Eduardo Back Sternick, Yash Lokhandwala, Hein J J Wellens
    Abstract:

    A case of a 22-year-old young pregnant woman with palpitations and near syncope is presented. Holter monitoring showed very frequent premature beats and runs of wide complex tachycardia, refractory to antiarrhythmic drugs. Electrophysiologic evaluation disclosed spontaneous automatism arising in an Atriofascicular Pathway. Differential diagnosis is discussed.

  • atypical bypass tracts can they be recognized during sinus rhythm
    Europace, 2019
    Co-Authors: Jose Nunes De Alencar Neto, Saulo Rodrigo Ramalho De Moraes, Eduardo Back Sternick, Hein J J Wellens
    Abstract:

    Atypical bypass tracts or variants of ventricular pre-excitation are rare anatomic structures often with rate-dependent slowing in conduction, called decremental conduction. During sinus rhythm, electrocardiographic recognition of those structures may be difficult because unlike in the Wolff-Parkinson-White syndrome where usually overt ventricular pre-excitation is present, the electrocardiogram (ECG) often shows a subtle pre-excitation pattern because of less contribution to ventricular activation over the slow and decrementally conducting bypass. Following the structure described by Ivan Mahaim and Benatt corresponding to a fasciculoventricular Pathway, several other new variants of ventricular pre-excitation were reported. In this review, we aim to discuss the electrocardiographic pattern of the different subtypes of variants of ventricular pre-excitation, including the Atriofascicular Pathway, long and short decrementally conducting atrioventricular Pathways, fasciculoventricular Pathway, the atrio-Hisian bypass tract, and nodoventricular and nodofascicular fibres. Emphasis will be on the ECG findings during sinus rhythm.

  • atypical bypass tracts can they be recognized during sinus rhythm
    Europace, 2019
    Co-Authors: Jose Nunes De Alencar Neto, Saulo Rodrigo Ramalho De Moraes, Eduardo Back Sternick, Hein J J Wellens
    Abstract:

    Atypical bypass tracts or variants of ventricular pre-excitation are rare anatomic structures often with rate-dependent slowing in conduction, called decremental conduction. During sinus rhythm, electrocardiographic recognition of those structures may be difficult because unlike in the Wolff-Parkinson-White syndrome where usually overt ventricular pre-excitation is present, the electrocardiogram (ECG) often shows a subtle pre-excitation pattern because of less contribution to ventricular activation over the slow and decrementally conducting bypass. Following the structure described by Ivan Mahaim and Benatt corresponding to a fasciculoventricular Pathway, several other new variants of ventricular pre-excitation were reported. In this review, we aim to discuss the electrocardiographic pattern of the different subtypes of variants of ventricular pre-excitation, including the Atriofascicular Pathway, long and short decrementally conducting atrioventricular Pathways, fasciculoventricular Pathway, the atrio-Hisian bypass tract, and nodoventricular and nodofascicular fibres. Emphasis will be on the ECG findings during sinus rhythm.

  • Atrial Premature Beats During Decrementally Conducting Antidromic Tachycardia
    Circulation. Arrhythmia and electrophysiology, 2013
    Co-Authors: Eduardo Back Sternick, Yash Lokhandwala, Carl Timmermans, Luiz Márcio Gerken, Frederico Soares, Liana Valadao Dias, Yan Huo, Gerhard Hindricks, Hein J J Wellens
    Abstract:

    Background— Advancement of ventricular activation by an atrial premature beat (APB) given during His bundle refractoriness followed by resetting of an antidromic tachycardia (AT) in patients with decrementally conducting accessory Pathway (DAP) is a helpful maneuver to prove Pathway existence and participation in the circuit. We aim to assess in a large cohort the role of APB during AT in patients with a DAP. Methods and Results— Thirty-three patients with a DAP having 34 AT were included in the study: 29 patients had an Atriofascicular Pathway, 1 had a long atrioventricular DAP, and 4 had a short atrioventricular fiber. APBs were delivered initially from the lateral right atrium, scanning diastole with a 10-ms decrement until AT termination or refractoriness. We observed 4 patterns of response after APB during AT: advancement of activation (29 cases), delay (2), advancement followed by delay (3), and termination (7). Eight patients required an earlier APB to advance or delay ventricular activation. These 8 patients had a shorter AT cycle length (median of 273 versus 315 ms; P =0.003) and had a shorter resetting zone (median coupling interval of 30 versus 50 ms; P =0.01). Conclusions— APB delivered during AT in patients with a DAP advanced and/or delayed ventricular activation in all patients. In 1 of 5 of cases the AT was terminated by a single APB. In approximately a quarter of the patients an earlier coupled APB was needed to reset AT. The high RA was an adequate stimulation site in all right-sided DAP.

  • The atrioventricular interval during pre-excited tachycardia: a simple way to distinguish between decrementally or rapidly conducting accessory Pathways.
    Heart rhythm, 2009
    Co-Authors: Eduardo Back Sternick, Yash Lokhandwala, Carl Timmermans, Luz Maria Rodriguez, Luiz Márcio Gerken, Ricardo Baeta Scarpelli, Frederico Soares, Hein J J Wellens
    Abstract:

    Background Recognition of the presence and role of decremental fibers during wide QRS tachycardia requires carefully executed intracardiac studies. Objective This study sought to determine the value of the atrioventricular (AV) conduction time during pre-excited tachycardia to differentiate a fast from a decrementally conducting accessory Pathway (AP). Methods Fifty-one patients with 56 pre-excited tachycardias were included in the study: Group I: 27 patients with 31 antidromic tachycardia (ADT) using an Atriofascicular Pathway, Group II: 2 patients with pre-excited tachycardia due to bystander AV conduction, Group III: 3 patients with ADT and a short AV Mahaim fiber, and Group IV: 19 patients with 21 ADT using a fast conducting right-sided AP. The AV interval was measured in the His bundle electrogram and related to the tachycardia cycle length (TCL) by making an AV/TCL index. Results An AV interval ≥ 150 ms during pre-excited tachycardia yielded a 91% sensitivity, 90% specificity, positive predictive value of 94%, and negative predictive value of 83% for AV conduction over a decrementally conducting Pathway, whereas a ≥0.55 AV/TCL index yielded a sensitivity of 89%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 84%. In 3 of 4 patients with Mahaim fibers and a Conclusions An AV interval ≥150 ms during pre-excited tachycardia is a fast and reliable method for detecting a decrementally conducting AP. Correcting the AV interval by the tachycardia cycle length improved specificity and positive predictive accuracy.

A. J. Camm - One of the best experts on this subject based on the ideXlab platform.

  • Supraventricular tachycardia. ECG diagnosis and anatomy
    European Heart Journal, 1997
    Co-Authors: O. A. Obel, A. J. Camm
    Abstract:

    This paper reviews the anatomical substrates responsible for the induction and maintenance of supraventricular tachycardia and discusses the ECG findings associated with these tachycardias. The normal anatomy of the supraventricular conducting system, particularly within the atria, is complex with conduction proceeding along preferential Pathways, which are in turn determined in part by the anisotropic properties of the atrial myocardium. There appear to be at least dual inputs to the atrioventricular node, a posteriorly situated slow Pathway and an anterior fast Pathway. It is sometimes possible to relate ECG findings directly to anatomical substrates: for example, in some cases of atrial tachycardia the site of the atrial focus (left or right, superior or inferior) can be determined by the polarity of the P wave. The anatomical substrates responsible for intra-atrial re-entry, atrial flutter and atrial fibrillation relate to anatomical barriers to impulse propagation and areas of slow conduction. In atrial flutter the crista terminalis, Eustachian valve, inferior vena cava, coronary sinus os, and tricuspid annulus have been identified as anatomical barriers to conduction around which a macro re-entrant circuit within the right atrium may conduct, usually in a counter-clockwise direction. Clockwise direction of conduction, and other mechanisms of tachycardia, occur in some of the less typical forms of atrial fluter. Atrial fibrillation is caused by multiple wavelets which randomly conduct through the atrial myocardium and are responsible for the irregular fibrillation waves' on the ECG. Supraventricular tachycardia presents as a narrow complex tachycardia unless pre-existing or rate-related bundle branch block is present. Less common causes for a broad complex tachycardia occurring in supraventricular tachycardia include an accessory atrioventricular or Atriofascicular Pathway conducting antegradely during tachycardia, or accessory Pathway participation as a bystander during supraventricular tachycardia. ECG features which can help to distinguish between atrioventricular nodal re-entrant tachycardia and atrioventricular re-entrant tachycardia include: (1) the presence of a δ wave during sinus rhythm which is highly suggestive of atrioventricular re-entrant tachycardia as the mechanism of supraventricular tachycardia; (2) the finding of a pseudo s (lead II) or pseudo r' (lead V 1 ) during tachycardia in atrioventricular nodal re-entrant tachycardia; (3) lengthening of the tachycardia cycle length in cases of atrioventricular re-entrant tachycardia when bundle branch block occurs ipsilateral to the accessory Pathway and (4) the finding of QRS alternans during tachycardia which is suggestive of atrioventricular re-entrant tachycardia. 'Long RP' tachycardia may be caused by an atrial tachycardia due to an inferiorly situated area of abnormal automaticity, atypical atrioventricular nodal re-entrant tachycardia with slow retrograde conduction, or atrioventricular re-entrant tachycardia with an accessory Pathway conducting slowly from ventricle to atrium during tachycardia.

  • Supraventricular tachycardia. ECG diagnosis and anatomy.
    European heart journal, 1997
    Co-Authors: O. A. Obel, A. J. Camm
    Abstract:

    This paper reviews the anatomical substrates responsible for the induction and maintenance of supraventricular tachycardia and discusses the ECG findings associated with these tachycardias. The normal anatomy of the supraventricular conducting system, particularly within the atria, is complex with conduction proceeding along preferential Pathway, which are in turn determined in part by the anisotropic properties of the atrial myocardium. There appear to be at least dual inputs to the atrioventricular node, a posteriorly situated slow Pathway and an anterior fast Pathway. It is sometimes possible to relate ECG findings directly to anatomical substrates; for example, in some cases of atrial tachycardia the site of the atrial focus (left or right, superior or inferior) can be determined by the polarity of the P wave. The anatomical substrates responsible for intra-atrial re-entry, atrial flutter and atrial fibrillation relate to anatomical barriers to impulse propagation and areas of slow conduction. In atrial flutter the crista terminalis, Eustachian valve, inferior vena cava, coronary sinus os, and tricuspid annulus have been identified as anatomical barriers to conduction around which a macro re-entrant circuit within the right atrium may conduct, usually in a counter-clockwise direction. Clockwise direction of conduction, and other mechanisms of tachycardia, occur in some of the less typical forms of atrial fluter. Atrial fibrillation is caused by multiple wavelets which randomly conduct through the atrial myocardium and are responsible for the irregular 'fibrillation waves' on the ECG. Supraventricular tachycardia presents as a narrow complex tachycardia unless pre-existing or rate-related bundle branch block is present. Less common causes for a broad complex tachycardia occurring in supraventricular tachycardia include an accessory atrioventricular or Atriofascicular Pathway conducting antegradely during tachycardia, or accessory Pathway participation as a bystander during supraventricular tachycardia. ECG features which can help to distinguish between atrioventricular nodal re-entrant tachycardia and atrioventricular re-entrant tachycardia include: (1) the presence of a delta wave during sinus rhythm which is highly suggestive of atrioventricular re-entrant tachycardia as the mechanism of supraventricular tachycardia; (2) the finding of a pseudo s (lead II) or pseudo r' (lead V1) during tachycardia in atrioventricular nodal re-entrant tachycardia; (3) lengthening of the tachycardia cycle length in cases of atrioventricular re-entrant tachycardia when bundle branch block occurs ipsilateral to the accessory Pathway and (4) the finding of QRS alternans during tachycardia which is suggestive of atrioventricular re-entrant tachycardia. "Long RP' tachycardia may be caused by an atrial tachycardia due to an inferiorly situated area of abnormal automaticity, atypical atrioventricular nodal re-entrant tachycardia with slow retrograde conduction, or atrioventricular re-entrant tachycardia with an accessory Pathway conducting slowly from ventricle to atrium during tachycardia.

O. A. Obel - One of the best experts on this subject based on the ideXlab platform.

  • Supraventricular tachycardia. ECG diagnosis and anatomy
    European Heart Journal, 1997
    Co-Authors: O. A. Obel, A. J. Camm
    Abstract:

    This paper reviews the anatomical substrates responsible for the induction and maintenance of supraventricular tachycardia and discusses the ECG findings associated with these tachycardias. The normal anatomy of the supraventricular conducting system, particularly within the atria, is complex with conduction proceeding along preferential Pathways, which are in turn determined in part by the anisotropic properties of the atrial myocardium. There appear to be at least dual inputs to the atrioventricular node, a posteriorly situated slow Pathway and an anterior fast Pathway. It is sometimes possible to relate ECG findings directly to anatomical substrates: for example, in some cases of atrial tachycardia the site of the atrial focus (left or right, superior or inferior) can be determined by the polarity of the P wave. The anatomical substrates responsible for intra-atrial re-entry, atrial flutter and atrial fibrillation relate to anatomical barriers to impulse propagation and areas of slow conduction. In atrial flutter the crista terminalis, Eustachian valve, inferior vena cava, coronary sinus os, and tricuspid annulus have been identified as anatomical barriers to conduction around which a macro re-entrant circuit within the right atrium may conduct, usually in a counter-clockwise direction. Clockwise direction of conduction, and other mechanisms of tachycardia, occur in some of the less typical forms of atrial fluter. Atrial fibrillation is caused by multiple wavelets which randomly conduct through the atrial myocardium and are responsible for the irregular fibrillation waves' on the ECG. Supraventricular tachycardia presents as a narrow complex tachycardia unless pre-existing or rate-related bundle branch block is present. Less common causes for a broad complex tachycardia occurring in supraventricular tachycardia include an accessory atrioventricular or Atriofascicular Pathway conducting antegradely during tachycardia, or accessory Pathway participation as a bystander during supraventricular tachycardia. ECG features which can help to distinguish between atrioventricular nodal re-entrant tachycardia and atrioventricular re-entrant tachycardia include: (1) the presence of a δ wave during sinus rhythm which is highly suggestive of atrioventricular re-entrant tachycardia as the mechanism of supraventricular tachycardia; (2) the finding of a pseudo s (lead II) or pseudo r' (lead V 1 ) during tachycardia in atrioventricular nodal re-entrant tachycardia; (3) lengthening of the tachycardia cycle length in cases of atrioventricular re-entrant tachycardia when bundle branch block occurs ipsilateral to the accessory Pathway and (4) the finding of QRS alternans during tachycardia which is suggestive of atrioventricular re-entrant tachycardia. 'Long RP' tachycardia may be caused by an atrial tachycardia due to an inferiorly situated area of abnormal automaticity, atypical atrioventricular nodal re-entrant tachycardia with slow retrograde conduction, or atrioventricular re-entrant tachycardia with an accessory Pathway conducting slowly from ventricle to atrium during tachycardia.

  • Supraventricular tachycardia. ECG diagnosis and anatomy.
    European heart journal, 1997
    Co-Authors: O. A. Obel, A. J. Camm
    Abstract:

    This paper reviews the anatomical substrates responsible for the induction and maintenance of supraventricular tachycardia and discusses the ECG findings associated with these tachycardias. The normal anatomy of the supraventricular conducting system, particularly within the atria, is complex with conduction proceeding along preferential Pathway, which are in turn determined in part by the anisotropic properties of the atrial myocardium. There appear to be at least dual inputs to the atrioventricular node, a posteriorly situated slow Pathway and an anterior fast Pathway. It is sometimes possible to relate ECG findings directly to anatomical substrates; for example, in some cases of atrial tachycardia the site of the atrial focus (left or right, superior or inferior) can be determined by the polarity of the P wave. The anatomical substrates responsible for intra-atrial re-entry, atrial flutter and atrial fibrillation relate to anatomical barriers to impulse propagation and areas of slow conduction. In atrial flutter the crista terminalis, Eustachian valve, inferior vena cava, coronary sinus os, and tricuspid annulus have been identified as anatomical barriers to conduction around which a macro re-entrant circuit within the right atrium may conduct, usually in a counter-clockwise direction. Clockwise direction of conduction, and other mechanisms of tachycardia, occur in some of the less typical forms of atrial fluter. Atrial fibrillation is caused by multiple wavelets which randomly conduct through the atrial myocardium and are responsible for the irregular 'fibrillation waves' on the ECG. Supraventricular tachycardia presents as a narrow complex tachycardia unless pre-existing or rate-related bundle branch block is present. Less common causes for a broad complex tachycardia occurring in supraventricular tachycardia include an accessory atrioventricular or Atriofascicular Pathway conducting antegradely during tachycardia, or accessory Pathway participation as a bystander during supraventricular tachycardia. ECG features which can help to distinguish between atrioventricular nodal re-entrant tachycardia and atrioventricular re-entrant tachycardia include: (1) the presence of a delta wave during sinus rhythm which is highly suggestive of atrioventricular re-entrant tachycardia as the mechanism of supraventricular tachycardia; (2) the finding of a pseudo s (lead II) or pseudo r' (lead V1) during tachycardia in atrioventricular nodal re-entrant tachycardia; (3) lengthening of the tachycardia cycle length in cases of atrioventricular re-entrant tachycardia when bundle branch block occurs ipsilateral to the accessory Pathway and (4) the finding of QRS alternans during tachycardia which is suggestive of atrioventricular re-entrant tachycardia. "Long RP' tachycardia may be caused by an atrial tachycardia due to an inferiorly situated area of abnormal automaticity, atypical atrioventricular nodal re-entrant tachycardia with slow retrograde conduction, or atrioventricular re-entrant tachycardia with an accessory Pathway conducting slowly from ventricle to atrium during tachycardia.

Jose Nunes De Alencar Neto - One of the best experts on this subject based on the ideXlab platform.

  • atypical bypass tracts can they be recognized during sinus rhythm
    Europace, 2019
    Co-Authors: Jose Nunes De Alencar Neto, Saulo Rodrigo Ramalho De Moraes, Eduardo Back Sternick, Hein J J Wellens
    Abstract:

    Atypical bypass tracts or variants of ventricular pre-excitation are rare anatomic structures often with rate-dependent slowing in conduction, called decremental conduction. During sinus rhythm, electrocardiographic recognition of those structures may be difficult because unlike in the Wolff-Parkinson-White syndrome where usually overt ventricular pre-excitation is present, the electrocardiogram (ECG) often shows a subtle pre-excitation pattern because of less contribution to ventricular activation over the slow and decrementally conducting bypass. Following the structure described by Ivan Mahaim and Benatt corresponding to a fasciculoventricular Pathway, several other new variants of ventricular pre-excitation were reported. In this review, we aim to discuss the electrocardiographic pattern of the different subtypes of variants of ventricular pre-excitation, including the Atriofascicular Pathway, long and short decrementally conducting atrioventricular Pathways, fasciculoventricular Pathway, the atrio-Hisian bypass tract, and nodoventricular and nodofascicular fibres. Emphasis will be on the ECG findings during sinus rhythm.

  • atypical bypass tracts can they be recognized during sinus rhythm
    Europace, 2019
    Co-Authors: Jose Nunes De Alencar Neto, Saulo Rodrigo Ramalho De Moraes, Eduardo Back Sternick, Hein J J Wellens
    Abstract:

    Atypical bypass tracts or variants of ventricular pre-excitation are rare anatomic structures often with rate-dependent slowing in conduction, called decremental conduction. During sinus rhythm, electrocardiographic recognition of those structures may be difficult because unlike in the Wolff-Parkinson-White syndrome where usually overt ventricular pre-excitation is present, the electrocardiogram (ECG) often shows a subtle pre-excitation pattern because of less contribution to ventricular activation over the slow and decrementally conducting bypass. Following the structure described by Ivan Mahaim and Benatt corresponding to a fasciculoventricular Pathway, several other new variants of ventricular pre-excitation were reported. In this review, we aim to discuss the electrocardiographic pattern of the different subtypes of variants of ventricular pre-excitation, including the Atriofascicular Pathway, long and short decrementally conducting atrioventricular Pathways, fasciculoventricular Pathway, the atrio-Hisian bypass tract, and nodoventricular and nodofascicular fibres. Emphasis will be on the ECG findings during sinus rhythm.