24. Cardiac Mapping in Variants of the Ventricular Preexcitation Syndrome

  1. Mohammad Shenasa MD4,
  2. Gerhard Hindricks MD5,
  3. Martin Borggrefe MD6,
  4. Günter Breithardt MD7 and
  5. Mark E. Josephson MD8
  1. Eduardo Back Sternick1,
  2. Yash Lokhandwala2 and
  3. Hein J. J. Wellens3

Published Online: 18 DEC 2012

DOI: 10.1002/9781118481585.ch24

Cardiac Mapping, Fourth Edition

Cardiac Mapping, Fourth Edition

How to Cite

Sternick, E. B., Lokhandwala, Y. and Wellens, H. J. J. (2013) Cardiac Mapping in Variants of the Ventricular Preexcitation Syndrome, in Cardiac Mapping, Fourth Edition (eds M. Shenasa, G. Hindricks, M. Borggrefe, G. Breithardt and M. E. Josephson), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781118481585.ch24

Editor Information

  1. 4

    Attending Physician, Department of Cardiovascular Services, O'Connor Hospital, Heart & Rhythm Medical Group, San Jose, California, USA

  2. 5

    Professor of Medicine (Cardiology), University Leipzig, Heart Center, Director, Department of Electrophysiology, Leipzig, Germany

  3. 6

    Professor of Medicine (Cardiology), Head, Department of Cardiology, Angiology and Pneumology, University Medical Center, Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany

  4. 7

    Professor Emeritus of Medicine and Cardiology, Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany

  5. 8

    Chief, Cardiovascular Medicine Division, Director, Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Beth Israel Deaconess Medical Center, Herman C. Dana Professor of Medicine, Harvard Medical School, Boston, Massachusetts, USA

Author Information

  1. 1

    Instituto de Pos Graduacao, Faculdade de Ciencias Medicas de Minas Gerais, Biocor Instituto, Belo Horizonte, Brazil

  2. 2

    Arrhythmia Associates, Mumbai, India

  3. 3

    CARIM, Cardiovascular Research Institute, Maastricht, The Netherlands

Publication History

  1. Published Online: 18 DEC 2012
  2. Published Print: 10 JAN 2013

ISBN Information

Print ISBN: 9780470670460

Online ISBN: 9781118481585

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Keywords:

  • ventricular preexcitation;
  • intracardiac conduction pathways;
  • atrial fibrillation ablation;
  • computed tomography;
  • electrocardiogram;
  • Wolff-Parkinson-White;
  • atriofascicular pathways;
  • atrioventricular nodal reentrant tachycardia;
  • intravenous verapamil

Summary

In this chapter we describe the identification, the structural-functional relation and the management of relatively rare intracardiac conduction pathways leading to variants of ventricular preexcitation. Their proper recognition is a must for the arrhythmologist involved in the ablative intracardiac treatment of these patients. Successively are discussed: atriofascicular pathways, short decrementally conducting accessory pathways, fasciculoventricular pathways, nodoventricular and nodofascicular pathways. Detailed information is given on how to use the appropriate electrophysiological maneuvers necessary to identify each of these variants, how to map them, and how to choose the best strategy for ablation, and how to document the success of that intervention. Special attention is given to the correct diagnosis of the fasciculoventricular pathways, when to be suspicious of the presence of a PRKAG2 mutation and how to correctly differentiate those from septal atrioventricular node (AV) pathways. Important knowledge to avoid the mistake of trying to ablate them with the potential of causing iatrogenic AV block, because they are not involved in tachycardia circuits.