Ahmed Karim Talib et al. JACEP 2015;1:

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Ahmed Karim Talib et al. JACEP 2015;1:369-380 Schematic Representation of the Intraventricular Activation Sequence During Sinus Rhythm, Common ILVT, and US-ILVT (A) During sinus rhythm, the impulse propagates antegradely down the left posterior fascicle (LPF) giving rise to P2 then the activation goes from P2 to P1 at the point of fusion; therefore, P1 is buried in the local ventricular activation. (B) During common ILVT, P1 and P2 are activated in the reverse direction. VT activation propagates antegradely from the basal to the apical site. (C) During US-ILVT, both the left anterior fascicle (LAF) and LPF are the antegrade limbs of the re-entrant circuit, whereas the retrograde activation occurs via the abnormal Purkinje fiber at the middle septum. All the hypothetical circuits are demonstrated in the RAO position. P1 refers to a specialized Purkinje tissue with decremental property and verapamil-sensitivity. The red undulating line represents a zone of slow conduction. The dotted lines indicate the unsolved parts in the circuit. LBB = left bundle branch; other abbreviations as in Figures 1, 2, and 3. Ahmed Karim Talib et al. JACEP 2015;1:369-380 American College of Cardiology Foundation