Diagnosis and treatment of patients with accessory pathways

Of the accessory pathways, partially or totally bypassing the atrio-ventricular conduction system, the bundle of Kent is the most common type. The electrocardiographic (ECG) expression of preexcitation depends upon the contribution of the activation fronts over the AV node and the accessory pathway. From the polarity of the delta wave in the surface ECG and from the behavior during electrophysiologic study, the location of the accessory pathway can be derived. The presence of an accessory pathway may induce circus movement tachycardia and, in case of atrial fibrillation, high ventricular rates possibly leading to sudden death. Noninvasive techniques are able to identify the patient at high risk. Treatment modalities are pharmacologic or surgical, whereas ablation techniques are still under investigation.