Case Report: An Unusual Case of Fasciculoventricular Pathway.

Liu Yang,Zhijian Chen,Min Zhang

doi:10.3389/fcvm.2022.818275

Abstract

A 30-year-old man with an ECG demonstrating ventricular preexcitation with a normal PR interval and a QR pattern in lead V1 was evaluated. Electrophysiology studies showed a normal AH interval and a shortened HV interval at sinus rhythm; while the degree of preexcitation (QRS waveform) and HV interval were not affected by multisite or incremental atrial pacing. These findings implied ventricular preexcitation due to a fasciculoventricular pathway (FVP). Moreover, temporarily blocking FVP conduction mechanically resulted in normal HV interval, absence of delta wave, and an rSR pattern in V1, which indicated incomplete right bundle branch block (IRBBB). These findings suggested the coexistence of FVP and IRBBB, which is very rare.

Highlights

Fasciculoventricular pathways (FVPs) are uncommon preexcitation variants
The ECG demonstrated the presence of delta waves during sinus rhythm (Figure 1), suggesting a manifest accessory pathway (AP) with antegrade conduction property
The QR pattern in V1 is different from what we usually see in a patient with ventricular preexcitation conducted over a right septal AP

Summary

INTRODUCTION

Fasciculoventricular pathways (FVPs) are uncommon preexcitation variants. Of note, a combination of FVPs with bundle branch blocks is barely observed. A 30-year-old man presented with an aberrant ECG performed 2 years ago. He was asymptomatic with unremarkable medical history. The ECG demonstrated the presence of delta waves during sinus rhythm (Figure 1), suggesting a manifest accessory pathway (AP) with antegrade conduction property. The QR pattern in V1 is different from what we usually see (a QS or rS pattern) in a patient with ventricular preexcitation conducted over a right septal AP. This necessitates an EPS for accurate diagnosis

A Case of Fasciculoventricular Pathway

DISCUSSION

CONCLUSION

ETHICS STATEMENT