Case Report (n=3)
Fasciculoventricular pathways are a rare cause of preexcitation in children that can mimic Wolff-Parkinson-White syndrome and require specific electrophysiologic criteria for accurate diagnosis.
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Requires specific EP criteria to avoid misdiagnosis as WPW in children; leaves open prevalence and management thresholds.
INTRODUCTION: Fasciculoventricular connections are the rarest form of accessory pathways leading to preexcitation. Electrophysiologic characteristics of these pathways include ventricular preexcitation with normal PR and AH intervals and short HV intervals during sinus rhythm. In addition, atrial overdrive pacing prolongs the PR interval without affecting the HV interval or the degree of preexcitation. METHODS AND RESULTS: From March 1994 through February 1997, 3 of 59 pediatric patients referred for electrophysiologic study for preexcitation on surface ECGs were found to have fasciculoventricular pathways. Two patients had no inducible supraventricular tachycardia. One patient had successful ablation of both a left lateral pathway and a concealed anterolateral pathway that had facilitated antidromic and orthodromic supraventricular tachycardias, respectively. CONCLUSION: Children often manifest minimal preexcitation via accessory AV pathways due to rapid AV conduction and/or left lateral pathway location. Fasciculoventricular pathways may masquerade as Wolff-Parkinson-White syndrome. Separation of the two diagnoses depends on the demonstration of specific electrophysiologic criteria.
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Sallee et al. (1999) conducted a case report in Preexcitation secondary to fasciculoventricular pathways (n=3). Fasciculoventricular pathways was evaluated on Electrophysiologic characteristics and inducible supraventricular tachycardia.
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