Lookup NU author(s): Professor Bob Anderson
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© 2019 Wiley Periodicals, Inc.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.
Author(s): Soares Correa F, Lokhandwala Y, Sanchez-Quintana D, Mori S, Anderson RH, Wellens HJJ, Back Sternick E
Publication type: Article
Publication status: Published
Journal: Journal of Cardiovascular Electrophysiology
Issue: ePub ahead of Print
Online publication date: 23/10/2019
Acceptance date: 12/10/2019
ISSN (print): 1045-3873
ISSN (electronic): 1540-8167
Publisher: Blackwell Publishing Inc.
PubMed id: 31646696
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