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Case Reports
. 2017 Nov;22(6):e12464.
doi: 10.1111/anec.12464. Epub 2017 May 12.

Intermittent preexcitation indicates "a low-risk" accessory pathway: Time for a paradigm shift?

Marek Jastrzębski  1 , Piotr Kukla  2 , Maciej Pitak  3 , Andrzej Rudziński  3 , Adrian Baranchuk  4 , Danuta Czarnecka  1
Affiliations
Case Reports

Intermittent preexcitation indicates "a low-risk" accessory pathway: Time for a paradigm shift?

Marek Jastrzębski et al. Ann Noninvasive Electrocardiol. 2017 Nov.

Abstract

We report three patients with intermittent loss of the preexcitation pattern in the ECG that had undergone an electrophysiological study. Despite apparently poorly conducting accessory pathway (AP), in each case a fast anterograde conduction, either during spontaneous atrial fibrillation or during incremental atrial pacing (on isoproterenol) was documented; shortest preexcited RR intervals of 200-240 ms were observed. We review the literature and conclude that intermittent preexcitation observed on resting 12-lead ECG lacks sufficient specificity for the diagnosis of an AP with long refractory period and cannot be considered a substitute for electrophysiological study in patients with this electrocardiographical phenomenon.

Keywords: Wolff-Parikinson-White syndrome; intermittent preexcitation; isoprenaline; sudden death.

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Figures

Figure 1
Figure 1
Upper panels: Fast preexcited atrial fibrillation with RR intervals of 200–240 ms. Lower panel: during electrophysiological study, 2:1 block in both the atrioventricular node and the accessory pathway (AP) during atrial pacing at 400 ms
Figure 2
Figure 2
(a) Intermittent complete loss of preexcitation unmasking first degree atrioventricular block. (b) 1:1 anterograde conduction through the accessory pathway (AP) at a rate of 250 bpm (on isoproterenol)
Figure 3
Figure 3
(a) 12‐lead resting ECG with intermittent, alternating preexcitation via left posterior accessory pathway. (b) Leads V1–V6 recorded during atrial pacing at a rate of 250 bpm showing 1:1 conduction (on isoproterenol)
See this image and copyright information in PMC

References

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