Abstract
The third reported case of intermittent Wolff-Parkinson-White syndrome as a manifestation of supernormal conduction is reported. It is also the first case of ventricular excitation by an atrial impulse conducted through an anomalous bypass in the presence of high grade atrioventricular block. The latter complicated the repair of a left ventricular-right atrial communication which was followed by progressively increasing impairment of atrioventricular conduction, presumably secondary to inflammation associated with surgery. Retrograde concealed conduction into the bypass of the immediately preceding paced ventricular wave of excitation is suggested as the basis for the supernormal state of the bypass tissue. Before institution of permanent pacing, excitation of both the atria and the bypass appeared to be responsive to fluxes in sympathetic tone, hemodynamic status or circulating catecholamines associated with exercise.
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