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J Cardiovasc Electrophysiol. 2008 Nov;19(11):1215-7. doi: 10.1111/j.1540-8167.2008.01203.x. Epub 2008 May 9.

Hypertrophic cardiomyopathy with preexcitation: insights from noninvasive electrocardiographic imaging (ECGI) and catheter mapping.

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1
Cardiac Bioelectricity and Arrhythmia Center, Washington University, St Louis, Missouri 63130-4899, USA.

Abstract

Hypertrophic Cardiomyopathy and Preexcitation.

INTRODUCTION:

Fasciculoventricular pathway has been described as an unusual variant of preexcitation. Electrocardiographic imaging (ECGI) is a novel imaging modality for noninvasive electroanatomic mapping of epicardial activation and repolarization.

CASE:

We present a case of an 18-year-old male with hypertrophic cardiomyopathy (HCM) and an electrocardiogram (ECG)-based diagnosis of Wolff-Parkinson-White (WPW) syndrome, who underwent a noninvasive ECGI study to image ventricular activation, followed by an electrophysiology study (EPS). The ECGI electroanatomic isochrone map showed early activation of the epicardial aspect of the atrioventricular (A-V) groove and an aberrant posterior-base-to-apex progression of activation in the left ventricular (LV) epicardium. The EPS showed a likely fasciculoventricular pathway (FVP) without any inducible tachycardia.

CONCLUSION:

While FVP has been described before, this is the first report of detailed quantitative three-dimensional characterization of electrical activation sequence of a heart with this type of preexcitation, using a novel noninvasive imaging modality (ECGI). In spite of abnormal ventricular activation, the EPS demonstrated that the FVP is not capable of supporting reentrant supraventricular tachycardia or rapidly conducted atrial fibrillation.

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PMID:
18479334
PMCID:
PMC2631093
DOI:
10.1111/j.1540-8167.2008.01203.x
[Indexed for MEDLINE]
Free PMC Article

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