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

Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc
Marek JastrzebskiDanuta Czarnecka

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.

References

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Aug 11, 2015·Pacing and Clinical Electrophysiology : PACE·Michelle E KigerKathryn K Collins
Dec 8, 2015·Journal of Cardiovascular Electrophysiology·Marek JastrzebskiDanuta Czarnecka
Mar 13, 2016·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·Hussam AliRiccardo Cappato

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