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Intermittent fixed preexcitation: What is the mechanism?
Elif Hande Ozcan Cetin1, Serkan Cay1, Ozcan Ozeke1
1University of Health Sciences, Ankara Bilkent City Hospital, Department of Cardiology, Ankara, Turkiye.
Journal of Electrocardiology
|September 26, 2025
Summary
Fasciculoventricular pathways (FV-APs) are rare pre-excitation variants with unique ECG features. Differentiating them from typical atrioventricular accessory pathways (AV-APs) is crucial before ablation.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Diagnostics
Background:
- Pre-excited complexes can occur via various accessory pathways, including the atrioventricular (AV) and atriofascicular (AF) pathways.
- Fasciculoventricular pathways (FV-APs) represent extremely rare variants of pre-excitation with distinct electrocardiogram (ECG) and electrophysiological characteristics.
Purpose of the Study:
- To describe the unique features of fasciculoventricular pathways (FV-APs).
- To highlight the importance of differentiating FV-APs from classical atrioventricular accessory pathways (AV-APs) prior to catheter ablation.
Main Methods:
- Analysis of distinctive ECG and electrophysiological features of FV-APs.
- Comparison of FV-AP characteristics with anteroseptal and mid-septal AV-APs.
Main Results:
- FV-APs originate from the His bundle and fascicles, terminating in the superoseptal region.
- Surface ECGs of FV-APs exhibit overlapping features with both anteroseptal and mid-septal AV-APs.
- FV-APs do not participate in atrioventricular reentrant tachycardia (AVRT) circuits and lack rapid antegrade conduction.
Conclusions:
- FV-APs are rare pre-excitation variants with specific anatomical origins and ECG findings.
- Accurate differentiation of FV-APs from AV-APs is essential for successful catheter ablation strategies.
- Failure to distinguish FV-APs may lead to ineffective ablation due to their non-participation in AVRT.
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