Philip M. Chang, MD, FHRS, CEPS, Akash R

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Presentation transcript:

Fasciculoventricular accessory pathways following repair of ventricular septal defects Philip M. Chang, MD, FHRS, CEPS, Akash R. Patel, MD, FHRS, CEPS, Peter Aziz, MD, FHRS, CEPS, Maully J. Shah, MBBS, FACC, FHRS HeartRhythm Case Reports Volume 1, Issue 5, Pages 331-336 (September 2015) DOI: 10.1016/j.hrcr.2015.05.005 Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 1 Cases 1 and 2 electrocardiogram (ECG) tracings. A: Case 1: Presurgery ECG demonstrating no preexcitation. B: Case 1: Pre-electrophysiological study ECG that demonstrates preexcitation. C: Case 2: Tilt-table ECG tracing capturing preexcited and nonpreexcited QRS complexes. HeartRhythm Case Reports 2015 1, 331-336DOI: (10.1016/j.hrcr.2015.05.005) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 2 Case 1: Response to atrial pacing. A: With ramp pacing, abrupt loss of preexcitation occurs (arrows) at a paced CL of 480 milliseconds with prolongation of the HV interval from 30 to 70 milliseconds. B: With extrastimulus pacing, the degree and pattern of ventricular preexcitation was fixed during S2 conduction. Of note, preexcitation also abruptly disappeared and reappeared during the S1 drive. C: At S1/S2 600 milliseconds/430 milliseconds, loss of preexcitation occurs along with HV prolongation from 24 to 68 milliseconds (**), indicating FV pathway ERP and conduction through the His-Purkinje system. HeartRhythm Case Reports 2015 1, 331-336DOI: (10.1016/j.hrcr.2015.05.005) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 3 Case 2: Atrial pacing and adenosine administration. A: Whereas pacing at 550 milliseconds, AV nodal Wenckebach occurs without change in HV interval or QRS configuration. B: With extrastimulus pacing at S1/S2 700milliseconds/570 milliseconds, AVNERP is observed. C: Following IV adenosine, complete AV block occurs without change in preexcitation before or after block. HeartRhythm Case Reports 2015 1, 331-336DOI: (10.1016/j.hrcr.2015.05.005) Copyright © 2015 Heart Rhythm Society Terms and Conditions