Unusual variants of pre-excitation: From anatomy to ablation: Part III-Clinical presentation, electrophysiologic characteristics, when and how to ablate nodoventricular, nodofascicular, fasciculoventricular pathways, along with considerations of permanent junctional reciprocating tachycardia

F.S. Correa, Y. Lokhandwala, D. Sanchez-Quintana, S. Mori, R.H. Anderson, H.J.J. Wellens, E.B. Sternick*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

10 Citations (Web of Science)

Abstract

The recognition of the presence, location, and properties of unusual accessory pathways for atrioventricular conduction is an exciting, but frequently a difficult, challenge for the clinical cardiac arrhythmologist. In this third part of our series of reviews, we discuss the different steps required to come to the correct diagnosis and management decision in patients with nodofascicular, nodoventricular, and fasciculo-ventricular pathways. We also discuss the concealed accessory atrioventricular pathways with the properties of decremental retrograde conduction that are associated with the so-called permanent form of junctional reciprocating tachycardia. Careful analysis of the 12-lead electrocardiogram during sinus rhythm and tachycardias should always precede the investigation in the catheterization room. When using programmed electrical stimulation of the heart from different intracardiac locations, combined with activation mapping, it should be possible to localize both the proximal and distal ends of the accessory connections. This, in turn, should then permit the determination of their electrophysiologic properties, providing the answer to the question "are they incorporated in a tachycardia circuit?". It is this information that is essential for decision-making with regard to the need for catheter ablation, and if necessary, its appropriate site.
Original languageEnglish
Pages (from-to)3097-3115
Number of pages19
JournalJournal of Cardiovascular Electrophysiology
Volume30
Issue number12
DOIs
Publication statusPublished - 1 Dec 2019

Keywords

  • accessory pathways
  • catheter ablation
  • fasciculoventricular
  • Mahaim fibers
  • nodofascicular
  • nodoventricular
  • permanent junctional reciprocating tachycardia
  • variants of pre-excitation
  • PARKINSON-WHITE-SYNDROME
  • QRS COMPLEX TACHYCARDIA
  • LONG RP TACHYCARDIA
  • TERM-FOLLOW-UP
  • ATRIOVENTRICULAR DISSOCIATION
  • ACCESSORY PATHWAY
  • SUPRAVENTRICULAR TACHYCARDIA
  • REENTRY TACHYCARDIA
  • CATHETER ABLATION
  • CONDUCTION

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