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Vol. 69. Issue 10.
Pages 979 (October 2016)
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Vol. 69. Issue 10.
Pages 979 (October 2016)
ECG Contest
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Response to ECG, September 2016
Respuesta al ECG de septiembre de 2016
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Adolfo Fontenla
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drfontenla@gmail.com

Corresponding author:
, Álvaro Lozano, María López-Gil
Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
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Rev Esp Cardiol. 2016;69:86510.1016/j.rec.2016.04.041
Adolfo Fontenla, Álvaro Lozano, María López-Gil
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While in sinus rhythm, the patient had a PR interval of 120ms and an apparently preexcited QRS, with a positive delta wave in inferior and precordial leads. During atrial fibrillation, there was no change in the QRS with respect to baseline, which ruled out a conventional accessory pathway (between the atrium and ventricle).

The preexcitation is explained by the presence of an accessory pathway inserted beneath the atrioventricular node, which connected the specific conduction system to the ventricle (fasciculoventricular). The onset of atrial fibrillation did not alter the QRS, as the atrioventricular node continued to “filter” the conduction of impulses to the ventricles.

The electrophysiological study (Figure) revealed an HV interval of 28ms (normal, between 35 and 55ms), a finding that confirmed the suspicion of preexcitation (Figure A). The patient had nodal reentrant tachycardias (Figure B) unrelated to the presence of the fasciculoventricular pathway (accessory pathways of this type do not participate actively in tachycardias).1

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(0.17MB).
Reference
[1]
M.A. Arias, M. Pachón, A. Puchol.
Diagnóstico electrocardiográfico de vía accesoria fasciculoventricular.
Rev Esp Cardiol., 67 (2014), pp. 575
Copyright © 2016. Sociedad Española de Cardiología
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