FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2610669265> ?p ?o ?g. }

• W2610669265 endingPage "1761" @default.
• W2610669265 startingPage "1759" @default.
• W2610669265 abstract "HomeCirculationVol. 135, No. 18Not Your Usual Pre-Excitation Free AccessCase ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCase ReportPDF/EPUBNot Your Usual Pre-Excitation Rajat Goyal, MD, Abhijeet Singh, MD and Roger Fan, MD Rajat GoyalRajat Goyal Search for more papers by this author , Abhijeet SinghAbhijeet Singh Search for more papers by this author and Roger FanRoger Fan Search for more papers by this author Originally published2 May 2017https://doi.org/10.1161/CIRCULATIONAHA.117.028386Circulation. 2017;135:1759–1761ECG ChallengeA 67-year-old man with a medical history of moderate to severe mitral regurgitation secondary to flail posterior mitral valve leaflet, hypertension, type II non–insulin-dependent diabetes mellitus, and paroxysmal atrial fibrillation was found to have the following ECG (Figure 1) after elective mitral valve repair. What abnormalities are present? Do you recommend further testing or treatment?Download figureDownload PowerPointFigure 1. ECG obtained after elective mitral valve repair.Please turn the page to read the diagnosis.Response to ECG ChallengeThe ECG (Figure 2) demonstrates normal sinus rhythm with pre-excitation but unexpectedly with progressively lengthening PR interval consistent with Mobitz I (Wenckebach) block. The seventh QRS complex (arrow) is a junctional escape beat that occurs simultaneously with a nonconducted P wave. Prominent delta waves are seen with all QRS complexes without a change in the degree of pre-excitation despite progressive atrioventricular block or with junctional escapes. In addition, there are nonconducted P waves. These findings demonstrate that the level of pre-excitation is below the level of the atrioventricular node. This ECG is therefore consistent with the diagnosis of a fasciculoventricular accessory pathway (FVAP).Download figureDownload PowerPointFigure 2. ECG findings. Sinus rhythm with fixed preexcitation and Mobitz I block. Arrow indicates a junctional escape beat with the same degree of pre-excitation. These findings confirm the presence of a fasciculoventricular accessory pathway.FVAPs are a rare occurrence, with an incidence of 1.2% to 5.1% of all pre-excitation syndromes.1 They take off below the atrioventricular node (from the His bundle or bundle branches) and insert directly into the ventricular septum, resulting in pre-excitation that is often subtle.2A surface ECG on its own is rarely able to differentiate between pre-excitation due to a typical atrioventricular accessory pathway and that from an FVAP, especially in patients with anteroseptal or midseptal bypass tracts.2 In a typical accessory pathway, atrioventricular nodal Wenckebach is usually not seen because it is masked by brisk antegrade conduction over the accessory pathway, resulting in a fixed P wave–to–delta wave time. No blocked P waves are seen either because there is always an alternative route to the ventricle. In patients with an FVAP, however, 3 specific ECG findings are seen. First, there is a fixed amount of pre-excitation despite progressive atrioventricular delay. Second, atrioventricular nodal block leads to an absence of atrioventricular conduction (ie, a dropped P wave). Last, when present, premature junctional beats (or junctional escape complexes) will exhibit the same degree of pre-excitation as sinus beats. The 3 findings taken together confirm that pre-excitation occurs below the level of the atrioventricular node and therefore the presence of an FVAP.Clinically, FVAPs are benign and have not been implicated in any arrhythmias.3 There is also no concern for 1-to-1 conduction of atrial fibrillation because the atrioventricular node is present to protect against this. Hence, no further clinical testing is required.3 This patient actually first presented with pre-excited atrial fibrillation with rapid ventricular response at the time of his diagnosis of flail mitral leaflet. Before surgery, he underwent electrophysiological study in which FVAP was diagnosed. No ablation was performed given the favorable prognosis associated with this diagnosis.DisclosuresNone.FootnotesCirculation is available at http://circ.ahajournals.org.Correspondence to: Roger Fan, MD, Stony Brook University Hospital, Heart Rhythm Center, HSC T16-080, Stony Brook, NY 11794. E-mail [email protected]References1. Suzuki T, Nakamura Y, Yoshida S, Yoshida Y, Shintaku H. Differentiating fasciculoventricular pathway from Wolff-Parkinson-White syndrome by electrocardiography.Heart Rhythm. 2014; 11:686–690. doi: 10.1016/j.hrthm.2013.11.018.CrossrefMedlineGoogle Scholar2. Sternick EB, Rodriguez LM, Gerken LM, Wellens HJ. Electrocardiogram in patients with fasciculoventricular pathways: a comparative study with anteroseptal and midseptal accessory pathways.Heart Rhythm. 2005; 2:1–6. doi: 10.1016/j.hrthm.2004.10.009.CrossrefMedlineGoogle Scholar3. Josephson ME. Preexcitation syndromes.In: Josephson’s Clinical Cardiac Electrophysiology: Techniques and Interpretations. 5th ed. Philadelphia, PA: Wolters Kluwer Health; 2016:434–436.Google Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Hoffmayer K, Han F, Singh D and Scheinman M (2020) Variants of accessory pathways, Pacing and Clinical Electrophysiology, 10.1111/pace.13830, 43:1, (21-29), Online publication date: 1-Jan-2020. May 2, 2017Vol 135, Issue 18 Advertisement Article InformationMetrics © 2017 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.117.028386PMID: 28461418 Originally publishedMay 2, 2017 PDF download Advertisement" @default.
• W2610669265 created "2017-05-12" @default.
• W2610669265 creator A5014851838 @default.
• W2610669265 creator A5073682603 @default.
• W2610669265 creator A5078590198 @default.
• W2610669265 date "2017-05-02" @default.
• W2610669265 modified "2023-09-27" @default.
• W2610669265 title "Not Your Usual Pre-Excitation" @default.
• W2610669265 cites W2023799559 @default.
• W2610669265 cites W2032795236 @default.
• W2610669265 doi "https://doi.org/10.1161/circulationaha.117.028386" @default.
• W2610669265 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/28461418" @default.
• W2610669265 hasPublicationYear "2017" @default.
• W2610669265 type Work @default.
• W2610669265 sameAs 2610669265 @default.
• W2610669265 citedByCount "1" @default.
• W2610669265 countsByYear W26106692652020 @default.
• W2610669265 crossrefType "journal-article" @default.
• W2610669265 hasAuthorship W2610669265A5014851838 @default.
• W2610669265 hasAuthorship W2610669265A5073682603 @default.
• W2610669265 hasAuthorship W2610669265A5078590198 @default.
• W2610669265 hasBestOaLocation W26106692651 @default.
• W2610669265 hasConcept C111773187 @default.
• W2610669265 hasConcept C126322002 @default.
• W2610669265 hasConcept C164705383 @default.
• W2610669265 hasConcept C178697064 @default.
• W2610669265 hasConcept C2775914520 @default.
• W2610669265 hasConcept C2776131983 @default.
• W2610669265 hasConcept C2776661526 @default.
• W2610669265 hasConcept C2777953023 @default.
• W2610669265 hasConcept C2779161974 @default.
• W2610669265 hasConcept C2779225596 @default.
• W2610669265 hasConcept C2780040984 @default.
• W2610669265 hasConcept C71924100 @default.
• W2610669265 hasConcept C84393581 @default.
• W2610669265 hasConceptScore W2610669265C111773187 @default.
• W2610669265 hasConceptScore W2610669265C126322002 @default.
• W2610669265 hasConceptScore W2610669265C164705383 @default.
• W2610669265 hasConceptScore W2610669265C178697064 @default.
• W2610669265 hasConceptScore W2610669265C2775914520 @default.
• W2610669265 hasConceptScore W2610669265C2776131983 @default.
• W2610669265 hasConceptScore W2610669265C2776661526 @default.
• W2610669265 hasConceptScore W2610669265C2777953023 @default.
• W2610669265 hasConceptScore W2610669265C2779161974 @default.
• W2610669265 hasConceptScore W2610669265C2779225596 @default.
• W2610669265 hasConceptScore W2610669265C2780040984 @default.
• W2610669265 hasConceptScore W2610669265C71924100 @default.
• W2610669265 hasConceptScore W2610669265C84393581 @default.
• W2610669265 hasIssue "18" @default.
• W2610669265 hasLocation W26106692651 @default.
• W2610669265 hasLocation W26106692652 @default.
• W2610669265 hasOpenAccess W2610669265 @default.
• W2610669265 hasPrimaryLocation W26106692651 @default.
• W2610669265 hasRelatedWork W1950350478 @default.
• W2610669265 hasRelatedWork W2080554614 @default.
• W2610669265 hasRelatedWork W2140392144 @default.
• W2610669265 hasRelatedWork W2156861234 @default.
• W2610669265 hasRelatedWork W2514291905 @default.
• W2610669265 hasRelatedWork W2525077838 @default.
• W2610669265 hasRelatedWork W2740161035 @default.
• W2610669265 hasRelatedWork W2891145291 @default.
• W2610669265 hasRelatedWork W4238005009 @default.
• W2610669265 hasRelatedWork W4380764369 @default.
• W2610669265 hasVolume "135" @default.
• W2610669265 isParatext "false" @default.
• W2610669265 isRetracted "false" @default.
• W2610669265 magId "2610669265" @default.
• W2610669265 workType "article" @default.