Miniseries 2-Septal and paraseptal accessory pathways-Part II : Para-Hisian accessory pathways-so-called anteroseptal pathways revisited
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2022. For permissions, please email: journals.permissionsoup.com..
Surgeons, when dividing bypass tracts adjacent to the His bundle, considered them to be 'anteroseptal'. The area was subsequently recognized to be superior and paraseptal, although this description is not entirely accurate anatomically, and conveys little about the potential risk during catheter interventions. We now describe the area as being para-Hisian, and it harbours two types of accessory pathways. The first variant crosses the membranous septum to insert into the muscular ventricular septum without exiting the heart, and hence being truly septal. The second variant inserts distally in the paraseptal components of the supraventricular crest, and consequently is crestal. The site of ventricular insertion determines the electrocardiographic expression of pre-excitation during sinus rhythm, with the two types producing distinct patterns. In both instances, the QRS and the delta wave are positive in leads I, II, and aVF. In crestal pathways, however, the QRS is ≥ 140 ms, and exhibits an rS configuration in V1-2. The delta wave in V1-2 precedes by 20-50 ms the apparent onset of the QRS in I, II, III, and aVF. In the true septal pathways, the QRS complex occupies ∼120 ms, presenting a QS, W-shaped, morphology in V1-2. The delta wave has a simultaneous onset in all leads. Our proposed terminology facilitates the understanding of the electrocardiographic manifestations of both types of para-Hisian pathways during pre-excitation and orthodromic tachycardia, and informs on the level of risk during catheter ablation.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:24 |
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| Enthalten in: |
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology - 24(2022), 4 vom: 05. Apr., Seite 650-661 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Farré, Jerónimo [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 07.04.2022 Date Revised 26.05.2022 published: Print Citation Status MEDLINE |
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| doi: |
10.1093/europace/euab293 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM335350658 |
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| 245 | 1 | 0 | |a Miniseries 2-Septal and paraseptal accessory pathways-Part II |b Para-Hisian accessory pathways-so-called anteroseptal pathways revisited |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2022. For permissions, please email: journals.permissionsoup.com. | ||
| 520 | |a Surgeons, when dividing bypass tracts adjacent to the His bundle, considered them to be 'anteroseptal'. The area was subsequently recognized to be superior and paraseptal, although this description is not entirely accurate anatomically, and conveys little about the potential risk during catheter interventions. We now describe the area as being para-Hisian, and it harbours two types of accessory pathways. The first variant crosses the membranous septum to insert into the muscular ventricular septum without exiting the heart, and hence being truly septal. The second variant inserts distally in the paraseptal components of the supraventricular crest, and consequently is crestal. The site of ventricular insertion determines the electrocardiographic expression of pre-excitation during sinus rhythm, with the two types producing distinct patterns. In both instances, the QRS and the delta wave are positive in leads I, II, and aVF. In crestal pathways, however, the QRS is ≥ 140 ms, and exhibits an rS configuration in V1-2. The delta wave in V1-2 precedes by 20-50 ms the apparent onset of the QRS in I, II, III, and aVF. In the true septal pathways, the QRS complex occupies ∼120 ms, presenting a QS, W-shaped, morphology in V1-2. The delta wave has a simultaneous onset in all leads. Our proposed terminology facilitates the understanding of the electrocardiographic manifestations of both types of para-Hisian pathways during pre-excitation and orthodromic tachycardia, and informs on the level of risk during catheter ablation | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Accessory pathway | |
| 650 | 4 | |a Anteroseptal pathway | |
| 650 | 4 | |a Electrocardiogram | |
| 650 | 4 | |a Intermediate septal pathway | |
| 650 | 4 | |a Mid-paraseptal pathway | |
| 650 | 4 | |a Midseptal pathway | |
| 650 | 4 | |a Para-Hisian pathway | |
| 650 | 4 | |a Pre-excitation | |
| 650 | 4 | |a Superoparaseptal pathway | |
| 700 | 1 | |a Anderson, Robert H |e verfasserin |4 aut | |
| 700 | 1 | |a Sánchez-Quintana, Damián |e verfasserin |4 aut | |
| 700 | 1 | |a Mori, Shumpei |e verfasserin |4 aut | |
| 700 | 1 | |a Rubio, José-Manuel |e verfasserin |4 aut | |
| 700 | 1 | |a García-Talavera, Camila |e verfasserin |4 aut | |
| 700 | 1 | |a Bansal, Raghav |e verfasserin |4 aut | |
| 700 | 1 | |a Lokhandwala, Yash |e verfasserin |4 aut | |
| 700 | 1 | |a Cabrera, José-Angel |e verfasserin |4 aut | |
| 700 | 1 | |a Wellens, Hein J J |e verfasserin |4 aut | |
| 700 | 1 | |a Sternick, Eduardo Back |e verfasserin |4 aut | |
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