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[Electrocardiographic characteristics of fasciculo-ventricular accessory pathways in children: A comparative study

Julián Andrés Olmedo1, Mauricio Sebastián Abello1, Bryan Cannon2

  • 1Servicio de Electrofisiología, Departamento de Cardiología, Instituto FLENI, Buenos Aires, Argentina.

Archivos De Cardiologia De Mexico
|July 2, 2017
PubMed

Insights

Fasciculo-ventricular (FV) and right anteroseptal (RAS) accessory pathways (AP's) in children have distinct ECG findings. FV AP's show a longer PR interval and narrower QRS, aiding non-invasive differentiation from RAS AP's.

Area of Science:

  • Pediatric Cardiology
  • Electrophysiology
  • Cardiac Electrophysiology

Background:

  • Fasciculo-ventricular (FV) and right anteroseptal (RAS) accessory pathways (AP's) share similar anatomical locations and electrocardiographic (ECG) characteristics.
  • Differentiating these AP's in children is crucial for accurate diagnosis and management.

Purpose of the Study:

  • To compare the electrocardiographic features of FV AP's and RAS AP's in pediatric patients.
  • To identify non-invasive methods for distinguishing between these two types of accessory pathways.

Main Methods:

  • Retrospective analysis of electrophysiological study data from pediatric patients with manifest pre-excitation.
  • ECG analysis by three independent, blinded observers to evaluate PR interval, QRS duration, and specific waveform characteristics.
  • FV AP's defined by HV interval ≤32ms and specific pacing responses; RAS AP's were similarly defined.

Main Results:

  • Out of 288 patients, 15 (5.2%) had FV AP's and 14 (4.9%) had RAS AP's.
  • FV AP's exhibited a significantly longer PR interval (113±21 ms vs 86±13 ms) and narrower QRS complex (95±12 ms vs 137±24 ms) compared to RAS AP's.
  • A rapid, low-amplitude deflection at the QRS onset was observed in 87% of FV AP patients versus 14% of RAS AP patients (P=.003).

Conclusions:

  • The PR interval is longer and the QRS complex is narrower in pediatric patients with FV AP's compared to RAS AP's.
  • The presence of a rapid, low-amplitude deflection at the QRS onset on ECG can help non-invasively differentiate FV AP's from RAS AP's in children.
Abstract

Keywords:
ArgentinaChildrenFasciculo-ventricular accessory pathwaysPediatríaSíndrome de WPWVías accesorias fascículoventricularesWPW syndrome

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