Concealed accessory pathways: Historical notes

Abstract

Concealment of an accessory pathway is caused by its ability to conduct retrogradely only. This variant of accessory pathway conduction could not be confirmed until invasive electrophysiology was introduced in the 1970s. As a rule, it is reported that concealed accessory pathways were predicted from animal experiments in 1971. However, even earlier studies suggested an accessory pathway or mechanisms comparable to those of the Wolff-Parkinson-White syndrome to be the cause of supraventricular tachycardias even though preexcitation during sinus rhythm had been lacking. Such interpretations were derived from clinical considerations, from patients having lost their ventricular preexcitation spontaneously, and from the disappearance of the delta wave after drug administration. Some authors postulated but did not provide the correct interpretation. Even a few contributions published before the paper of Wolff, Parkinson, and White in 1930 are worth considering in this context.