Atrial fibrillation in the preexcitation syndrome

One hundred patients with proved accessory pathways of the Kent bundle type were studied with multiple intracardiac catheters. During the procedure 16 had atrial fibrillation. Two patterns of induction of atrial fibrillation were noted. In most patients an earlier than expected atrial deflection appeared in one of the atrial recordings and was followed by atrial flutter (cycle length less than 220 msec) or atrial fibrillation either immediately or after a brief period of acceleration of atrial rate. In a few patients, intraatrial conduction delay, manifested as 2:1 block or Wenckebach block from the right to the left atrium or vice versa, occurred before the onset of atrial fibrillation. The incidence of atrial fibrillation was not statistically related to any associated cardiac abnormalities. A significantly large incidence of ventricular fibrillation was recorded in patients who had documented atrial fibrillation either before admission or during the catheter study.