Fibrosis in accessory atrioventricular pathways may provide an anatomic basis for impaired antegrade conduction in Wolff-Parkinson-White syndrome.
May explain antegrade block in select WPW cases; single case leaves open generalizability and clinical relevance.
We present a patient with Wolff-Parkinson-White syndrome who died of a myocardial infarction 19 months after clinical electrophysiologic studies. These studies suggested the presence of a left atrioventricular accessory pathway that sustained conduction well in the retrograde direction but only intermittently in the antegrade direction. Postmortem examination of the heart revealed three accessory atrioventricular pathways in proximity to each other in the posterolateral atrioventricular region. One pathway showed complete fibrosis and two showed patchy fibrosis. The fibrosis suggests an anatomic basis for the impaired antegrade conduction observed in life.
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Klein et al. (1980) studied this question.
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