Atypical bypass tracts: can they be recognized during sinus rhythm?

J.N.D. Neto, S.R.R. de Moraes, E.B. Sternick*, H.J.J. Wellens

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

13 Citations (Web of Science)

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.
Original languageEnglish
Pages (from-to)208-218
Number of pages11
JournalEP Europace
Volume21
Issue number2
DOIs
Publication statusPublished - 1 Feb 2019

Keywords

  • accessory pathways
  • algorithm
  • arrhythmias
  • atrioventricular-conduction
  • atypical bypass tracts
  • electrocardiogram
  • electrocardiogram findings
  • fasciculoventricular pathways
  • natural-history
  • nodoventricular mahaim fiber
  • p-r interval
  • parkinson-white-syndrome
  • pre-excitation
  • supraventricular tachycardia
  • variants
  • P-R INTERVAL
  • ALGORITHM
  • NATURAL-HISTORY
  • Atypical bypass tracts
  • ACCESSORY PATHWAYS
  • ELECTROCARDIOGRAM
  • Electrocardiogram findings
  • FASCICULOVENTRICULAR PATHWAYS
  • Pre-excitation
  • SUPRAVENTRICULAR TACHYCARDIA
  • PARKINSON-WHITE-SYNDROME
  • Variants
  • ATRIOVENTRICULAR-CONDUCTION
  • NODOVENTRICULAR MAHAIM FIBER
  • Arrhythmias

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