Why the study?
Does intermittent preexcitation on resting 12-lead ECG reliably indicate a low-risk accessory pathway?
Does intermittent preexcitation on resting 12-lead ECG reliably indicate a low-risk accessory pathway?
Intermittent preexcitation on resting ECG is insufficiently specific for diagnosing a low-risk accessory pathway and cannot replace electrophysiological study.
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Intermittent preexcitation does not preclude rapid conduction; hypothesis-generating for ECG-based risk stratification in preexcitation syndromes.
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.
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Jastrzębski et al. (2017) studied this question.
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