2005
DOI: 10.1046/j.1540-8167.2005.40522.x
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An Unusual Accessory Pathway: Anteroseptal to Ventricular Outflow Region Connection

Abstract: Accessory pathways are typically located along the left or right atrioventricular junction. Distinct ventricular pre-excitation patterns determined by surface electrocardiography can provide reasonable pathway localization prior to invasive mapping and catheter ablation. We report an accessory pathway producing an unusual electrocardiographic appearance suggestive of ventricular outflow region pre-excitation. Pacing maneuvers and standard intracardiac recordings confirmed an atrial insertion immediately adjace… Show more

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Cited by 10 publications
(8 citation statements)
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“…As a result of the fascicle‐like remnants in the adult outflow tract, confusion with activation mapping and pace mapping sometimes results 31 . These fascicle like developmental remnants may or may not connect with the adult conduction system (dead‐end fascicle) 32 . Even if these fibers are not the origin of the arrhythmia, proximity to the focus can result in relatively fast conduction to nonneighboring myocardial tissue, and pace mapping may produce variable results depending on the output for pacing.…”
Section: Anatomic Considerations 5: During Development and In The Adumentioning
confidence: 99%
“…As a result of the fascicle‐like remnants in the adult outflow tract, confusion with activation mapping and pace mapping sometimes results 31 . These fascicle like developmental remnants may or may not connect with the adult conduction system (dead‐end fascicle) 32 . Even if these fibers are not the origin of the arrhythmia, proximity to the focus can result in relatively fast conduction to nonneighboring myocardial tissue, and pace mapping may produce variable results depending on the output for pacing.…”
Section: Anatomic Considerations 5: During Development and In The Adumentioning
confidence: 99%
“…It is possible that such pathways may be the reason why some “right anteroseptal pathways” require prolonged ablation with high energy delivery and why some recur despite initial conduction block. Another reported unusual pathway in the anteroseptal region connected the right ventricular outflow tract (RVOT) myocardium to the anteroseptal atrium 16 . Since the immediate anterior neighbor of the right coronary cusp is the infundibular portion of the RVOT, although not attempted, ablation in the RCC may have been successful in this reported case as well (Fig.…”
Section: Discussionmentioning
confidence: 71%
“…Because of the relationship of the noncoronary cusp to the atrial septum, many of these epicardial pathways could be safely ablated by energy delivery in the noncoronary cusp at a location where an accessory pathway potential was recorded. Other reports specifically addressing left‐sided anteroseptal pathways have described ablation of these pathways at the region of the aortomitral continuity, both the left and noncoronary cusps of the aortic valve and distally in the LV outflow tract away from the His–Purkinje system 3–9 …”
Section: Discussionmentioning
confidence: 99%
“…Other reports specifically addressing left-sided anteroseptal pathways have described ablation of these pathways at the region of the aortomitral continuity, both the left and noncoronary cusps of the aortic valve and distally in the LV outflow tract away from the His-Purkinje system. [3][4][5][6][7][8][9] Our patient had a concealed decremental AP, and mapping was performed during tachycardia looking for a possible accessory pathway potential or a site of early atrial activation at the mitral annulus and left or noncoronary aortic cusp regions. At none of these sites was a possible AP potential found.…”
Section: Discussionmentioning
confidence: 99%
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