1. Atypical bypass tracts: can they be recognized during sinus rhythm?
- Subjects
variants ,pre-excitation ,electrocardiogram findings ,natural-history ,ELECTROCARDIOGRAM ,Arrhythmias ,atypical bypass tracts ,NODOVENTRICULAR MAHAIM FIBER ,atrioventricular-conduction ,accessory pathways ,SUPRAVENTRICULAR TACHYCARDIA ,fasciculoventricular pathways ,p-r interval ,ALGORITHM ,PARKINSON-WHITE-SYNDROME - Abstract
Atypical bypass tracts or variants of ventricular pre-excitation are rare anatomic structures often with rate-dependent slowing in conduction, called decremental conduction. During sinus rhythm, electrocardiographic recognition of those structures may be difficult because unlike in the Wolff-Parkinson-White syndrome where usually overt ventricular pre-excitation is present, the electrocardiogram (ECG) often shows a subtle pre-excitation pattern because of less contribution to ventricular activation over the slow and decrementally conducting bypass. Following the structure described by Ivan Mahaim and Benatt corresponding to a fasciculoventricular pathway, several other new variants of ventricular pre-excitation were reported. In this review, we aim to discuss the electrocardiographic pattern of the different subtypes of variants of ventricular pre-excitation, including the atriofascicular pathway, long and short decrementally conducting atrioventricular pathways, fasciculoventricular pathway, the atrio-Hisian bypass tract, and nodoventricular and nodofascicular fibres. Emphasis will be on the ECG findings during sinus rhythm.
- Published
- 2019