His bundle recordings in a case of complete atrioventricular block combined with pre-excitation syndrome

A rare coexistence of complete atrioventricular block and preexcitation in an elderly symptomatic patient

“…Why the patient had not developed any symptoms so far remains to be speculated, but one plausible explanation might be a consistent 1 : 1 antegrade conduction through the accessory pathway, whose antegrade refractory period for some reason seems to be remarkably increased with progressive conduction disturbance in the atrioventricular node during the last several weeks causing paroxysmal atrioventricular block. The coexistence of congenital atrioventricular block and ventricular preexcitation, detected usually during early childhood as well as before nonevident preexcitation after His bundle ablation in adults, has been rarely described in isolated case reports [1][2][3][4][5][6][7]. In addition, a clinical study systematically evaluated the relation between the conduction properties of the atrioventricular node and the antegrade conduction ability over the accessory pathway in the Wolff-Parkinson-White (WPW) syndrome.…”

Atrioventricular conduction: a determinant for the manifestation of ventricular preexcitation in patients with Wolff–Parkinson–White syndrome

“…In steep contrast, no patient in the other groups had atrioventricular block. In the literature, many have remarked on the coexistence of atrioventricular block and Wolff–Parkinson–White syndrome (Seipel et al ., 1976; Mossuti et al ., 1990). Belokon & Barinova (1984) also found a high prevalence of first degree atrioventricular block in children with preexcitation.…”

“…It is possible that degeneration process may be more pronounced in the threads of the accessory pathway than in the normal conduction system (Klein et al ., 1980) However, old age and long anterograde effective refractory period of the accessory pathway may also be characteristic of patients in whom the accessory pathway have gradually lost the anterograde conduction capacity with age because of their rapid atrioventricular conduction. In connection with the early disappearance and subsequent re‐emergence of preexcitation in the first two decades of life (Lunberg, 1973; Deal et al ., 1985; Perry & Garson, 1990; Sano et al ., 1998), and the combination with relatively long atrioventricular conduction time and block (Seipel et al ., 1976; Belokon & Barinova, 1984; Pfeiffer et al ., 1986; Mossuti et al ., 1990; Visman et al ., 1993; Sasaki et al ., 1995; Nabar et al ., 1998), it is suggested that the retention of the accessory pathway in the myocardium may be compensatory in nature in patients with delayed physiological or pathological atrioventricular conduction. Yet, they may precipitate dysrhythmias.…”

“…During the evaluation of atrioventricular conduction in these studies, however, patients with manifest and concealed accessory pathway was pooled together and a small patient population was recruited. The association of depressed atrioventricular conduction and preexcitation, such as coexistence of atrioventricular block and ventricular preexcitation (Seipel et al ., 1976; Belokon & Barinova, 1984; Mossuti et al ., 1990) and appearing of previously non‐evident preexcitation after His bundle ablation (Pfeiffer et al ., 1986; Visman et al ., 1993; Sasaki et al ., 1995; Nabar et al ., 1998), has been noted in isolated case report. There has been no systematic evaluation of the relation between the atrioventricular conduction properties of the atrioventricular node and the anterograde conduction ability over the accessory pathway.…”

Atrial Flutter in a Patient with Postoperative AV Block and Right Infero‐Septal Accessory Pathway: How to Preserve AV Conduction

“…A few cases of Wolff‐Parkinson‐White syndrome in combination with spontaneous or perioperative complete AV block have been published, for example, Ref. 2. Because of the location of the AP, the typical “isthmus” ablation of the inferior cavotricuspid isthmus would have been associated with a high risk of damage to the AP and of lifetime pacemaker dependency.…”