Key result
A novel distal type of nodo-ventricular pathway resembling a fasciculo-ventricular pathway was identified and unexpectedly eliminated during slow pathway ablation.
Why the study?
Fasciculo-ventricular and nodo-ventricular pathways are rare preexcitation variants that are normally electrophysiologically distinct, but variants emerging from the distal slow pathway can mimic each other.
Case Report
Demonstrates a novel 'distal type' nodo-ventricular pathway that mimics a fasciculo-ventricular pathway but can be distinguished by HV interval comparison and eliminated via slow pathway ablation.
Alerts electrophysiologists to distal nodo-ventricular variants during SVT ablation; leaves open prevalence, mechanisms, and management implications.
Fasciculo-ventricular and nodo-ventricular pathways (FVP and NVP) are rare preexcitation variants. Normally, NVP is electrophysiologically different from FVP. We describe a unique type of NVP emerging from the distal part of the slow pathway, designated as "distal type" NVP. The distal type NVP resembled FVP but was proven by unexpected elimination of the NVP during the slow pathway ablation. Also, NVP was distinguishable from FVP by a careful comparison of the HV intervals during conduction over the fast and slow pathways. Demonstration of this novel type NVP provides insights into how the insertion site of NVP affects its electrophysiologic behaviors.
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Uetake et al. (2022) conducted a case report in Preexcitation variants (nodo-ventricular pathway). Slow pathway ablation was evaluated on Elimination of the NVP. A novel distal type of nodo-ventricular pathway resembling a fasciculo-ventricular pathway was identified and unexpectedly eliminated during slow pathway ablation.
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