Journal of Arrhythmia (Jan 2010)

Electrocardiographic Characteristics of Fasciculoventricular Pathways: Analysis of Five Cases

  • Akihiro Saito, MD,
  • Yoshiaki Kaneko, MD PhD,
  • Tadashi Nakajima, MD PhD,
  • Tadanobu Irie, MD,
  • Masaki Ota, MD,
  • Toshimitsu Kato, MD,
  • Takafumi Iijima, MD,
  • Toshio Ito, MD,
  • Mamoru Manita, MD PhD,
  • Masahiko Kurabayashi, MD PhD

DOI
https://doi.org/10.1016/S1880-4276(10)80005-5
Journal volume & issue
Vol. 26, no. 3
pp. 181 – 188

Abstract

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Introduction: Fasciculoventricular (FV) accessory pathways are rare variants of preexcitation syndrome and published data on the ECG of FV pathways are limited. The purpose of this study was to analyze the electrocardiographic characteristics of FV pathways. Methods: We enrolled 5 patients (mean age, 26.8 ± 15.1 years; range 15–49 years, 2 male) with FV pathways which were diagnosed based on the standard electrophysiologic criteria. According to the standard criteria for the ECG classification of manifest Wolff-Parkinson-White (WPW) syndrome, the ECGs were classified as type A, B or C. The polarity of delta wave in each lead of each patient was divided into positive, flat or negative and was applied to the stepwise ECG algorithms of atrioventricular accessory pathway previously published by Fitzpatrick, Arruda and Iturralde. Results: Type A was found in one patient (Case No 4), type B in one patient (Case No 5) and type C in three patients (Case No 1, 2 and 3). Based on stepwise ECG algorithm, all cases corresponded to the polarity of the delta wave in patients with right anteroseptal, posteroseptal, right anterolateral or left anterolateral AP. In all three cases exhibiting type C, the polarity of delta wave in lead V2 was flat. Conclusions: ECGs of FV pathways may be misidentified as ECG of WPW syndrome, and may present with any preexcitation pattern of type A, B or C.

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