Key result
EP testing reveals bystander fasciculoventricular pathways with no inducible arrhythmias after VSD repair.
Case Report (n=2)
First report describing acquired or unmasked fasciculoventricular pathways after surgical VSD repair, highlighting the importance of invasive electrophysiology testing to distinguish benign bystander pathways from arrhythmogenic accessory pathways and prevent unnecessary ablation.
The most common form of preexcitation in the pediatric population is due to Wolff-Parkinson-White syndrome (WPW) where atrioventricular (AV) conduction occurs partially or entirely through a congenital accessory AV bypass tract.1 Acquired WPW has been described when AV accessory pathways develop across suture lines after surgery for congenital heart disease (CHD).2–3 Fasciculoventricular (FV) pathways that manifest after CHD surgery have not been described previously. Although FV pathways do not participate in arrhythmias, their effects manifest as de novo preexcitation on surface electrocardiograms (ECGs).
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Chang et al. (2015) conducted a case report in Acquired ventricular preexcitation via fasciculoventricular accessory pathways following surgical repair of conoventricular ventricular septal defects (n=2). Invasive diagnostic electrophysiology study (EPS) following surgical repair of conoventricular ventricular septal defect was evaluated on Electrophysiological characterization of ventricular preexcitation and inducibility of supraventricular tachycardia.
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