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Anatomic Basis for Preexcitation Syndromes

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Cardiac Preexcitation Syndromes

Abstract

The usual and normal route to ventricular excitation is via the sino-auricular nodeatrioventricular (AV) node-His bundle-bundle branch system. The AV node is a region in which impulse conduction is normally delayed. Although the mechanism for the this delay is not agreed upon, it is an important feature of the AV node which helps to maintain an orderly sequence of atrial and ventricular contraction. However, there are several potential routes, by which the normal AV node-common bundle pathway may be bypassed, and which are, for the most part, made up of morphologically normal myocytes which often permit initiation of ventricular depolarization prior to that anticipated from activation via the normal conduction system. The main contribution of this chapter will be to describe these various potential bypass pathways which provide an anatomical basis for the occurrence of preexcitation. The terminology used will, for the most part, be that recommended by the European Study Group for Preexcitation [1].

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References

  1. Anderson RH, Becker AE, Brechenmacher C, Davies MJ, Rossi L: Ventricular preexcitation A proposed nomenclature for its substrates. Eur. J. Cardiol. 31: 27, 1975.

    Google Scholar 

  2. Purkinje JE: Microsckopisch neurologische Beobachtungen. Arch fur Anat. Physiol. Wissenschaftliche Medecin 12: 281, 1845.

    Google Scholar 

  3. Kent AFS: Researches on the structure and function of the mammalian heart. J. Physiol. 14: 233, 1893.

    Google Scholar 

  4. His W Jr: Die Tatigkeit des embryonalen Herzens and deren Bedeutung fur die Lehre von der Herzbewegung beim Erwachsenen. Arbeit a.d. medicin Klinik zu Leipzig xx: pp. 14–49, 1893.

    Google Scholar 

  5. Tawara S: Das reizleitungssystem des Saugetierherzens. Jena. Gustav Fischer, 1906.

    Google Scholar 

  6. Keith A, Flack M: The auriculo-ventricular bundle of the human heart. Lancet 2: 359, 1906.

    Article  Google Scholar 

  7. Keith A, Flack M: The form and nature of the muscular connections between the primary divisions of the vertebrate heart. J. Anat. Physiol. 41: 172, 1907.

    PubMed  CAS  Google Scholar 

  8. Wenckebach KF: Beitrage zur Kenntnis der mennschlichen Herztatigkeit. Arch Anat. Physiol. 2: 1, 1907.

    Google Scholar 

  9. Wood FC, Wolferth CC, Geckeler GD: Histologic demonstration of accessory muscular connections between auricle and ventricle in a case of short PR interval and prolonged QRS complex. Am. Heart J. 25: 454, 1943.

    Article  Google Scholar 

  10. Robb JS, Kaylor CT, Turman WG: A study of specialized heart tissue at various stages of development of the human fetal heart. Am. J. Med. 5: 324, 1948.

    Article  PubMed  CAS  Google Scholar 

  11. Sealy WC: Effectiveness of surgical management of the Wolff-Parkinson-White syndrome. Am. J. Surg. 145: 756, 1983.

    Article  PubMed  CAS  Google Scholar 

  12. Cobb FR, Blumenschein SD, Sealy WC, Boineau JP, Wagner GS, Wallace AG: Successful surgical interruption of the bundle of Kent in a patient with Wolff-Parkinson-White syndrome. Circulation 38: 1018, 1968.

    PubMed  CAS  Google Scholar 

  13. Gallagher JJ, Gilbert M, Svenson RH, Sealy WC, Kasell J, Wallace AG: Wolff-Parkinson-White syndrome. The problem, evaluation, and surgical correction. Circulation 51: 767, 1975.

    PubMed  CAS  Google Scholar 

  14. Becker AG, Anderson RW, Durrer D, Wellens HJ: The anatomical substrates of WolffParkinson-White syndrome. A clinicopathological condition seen in patients. Circulation 57: 870, 1978.

    PubMed  CAS  Google Scholar 

  15. Sealy WC, Gallagher JJ, Wallace AG: The surgical treatment of Wolff-Parkinson-White syndrome. Evaluation of improved methods for identification and interruption of the Kent bundle. Ann. Thorac. Surg. 22: 443, 1976.

    Article  PubMed  CAS  Google Scholar 

  16. Klein G, Guiraudon GM, Perkins DG, Jones DL, Yee R, Jarvis E: Surgical correction of the Wolff-Parkinson-White syndrome in the closed heart using cryosurgery. JACC 3: 405, 1984.

    CAS  Google Scholar 

  17. Truex RC, Bishof JK, Hoffman EL: Accessory atrioventricular muscle bundles of the developing human heart. Anat. Rec. 131: 45, 1958.

    Article  PubMed  CAS  Google Scholar 

  18. Lev M, Lerner R: The theory of Kent. A histologic study of the normal AV communications of the human heart. Circulation 12: 176, 1955.

    PubMed  CAS  Google Scholar 

  19. Lev M, Fox SM, Bharati S, Greenfield JC, Rosen KM, Pick A: Mahaim and James fibers as a basis for a unique variety of ventricular preexcitation. Am. J. Cardiol. 36: 880, 1975.

    Article  PubMed  CAS  Google Scholar 

  20. Ferrer MI: New concepts relating to the preexcitation syndrome JAMA 201: 1038, 1967.

    CAS  Google Scholar 

  21. James TN: Morphology of the human AV node, with remarks pertinent to its electrophysiology. Am. Heart J. 62: 756, 1961.

    Article  PubMed  CAS  Google Scholar 

  22. Rossi L, Rovelli F: Anomalia del sistema atrioventricolare in un caso di sindrome di WPW. Riv. Anat. Patol. Oncol, 9: 160, 1955.

    Google Scholar 

  23. Greene HL: Accessory AV conduction syndrome. J. Hopkins Med. J. 139: 13, 1976.

    CAS  Google Scholar 

  24. Rosen KM, Mehta A, Miller RA: Demonstration of dual atrioventricular nodal pathways in man. Am. J. Cardiol. 33: 291, 1974.

    Article  PubMed  CAS  Google Scholar 

  25. Caracta AR, Damato AN, Callagher JJ, Josephson ME, Varghese PJ, Lua SH, Westura EE: Electrophysiologic studies in the syndrome of short PR interval, normal QRS complex. Am. J. Cardiol. 31: 245, 1973.

    Article  PubMed  CAS  Google Scholar 

  26. Lev M, Gibson S, Miller RA: Ebstein’s disease with WPW syndrome. Am. Heart J. 49: 724, 1958.

    Article  Google Scholar 

  27. Lown B, Ganong WF, Levine SA: The syndrome of short PR interval, normal QRS complex and paroxysmal rapid heart action, Circulation 5: 693, 1952.

    PubMed  CAS  Google Scholar 

  28. Brechenmacher C: Atrio-His bundle tracts. Brit. Heart J. 37: 853, 1975.

    Article  PubMed  CAS  Google Scholar 

  29. Narula OS: Retrograde preexcitation. Comparison of antegrade and retrograde conduction intervals in man. Circulation 50: 1129, 1974.

    PubMed  CAS  Google Scholar 

  30. Gillette PC: Concealed anomalous cardiac conduction pathways: a frequent cause of supra-ventricular tachycardia. Am. J. Cardiol. 40: 848, 1977.

    Article  PubMed  CAS  Google Scholar 

  31. Klein GJ, Hackel DB, Gallagher JJ: Anatomic substrate of impaired antegrade conduction over an accessory AV pathway in the WolffParkinson-White syndrome. Circulation 61: 1249, 1980.

    PubMed  CAS  Google Scholar 

  32. Lev M: Normal anatomy of the conduction system in man and its pathology in AV block. Ann. N.Y. Acad. Sci. 111: 817, 1964.

    Article  PubMed  CAS  Google Scholar 

  33. Brechenmacher C, Coumel P, Fauchier JP, Cachera JP, James TN: Di Subitaneis Mortibus XXII. Circulation 55: 404, 1977.

    Google Scholar 

  34. Harper JR, Harley A, Hackel DB, Estes EF: Coronary artery disease and major conduction disturbances. Am. Heart J. 77: 411, 1969.

    Article  PubMed  CAS  Google Scholar 

  35. Pickett JP, Sommer JR. Thirty five mm film as a mounting base and plastic spray as cover glass for histologic sections. Arch. Pathol. 69: 239, 1960.

    PubMed  CAS  Google Scholar 

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© 1986 Martinus Nijhoff Publishing

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Hackel, D.B. (1986). Anatomic Basis for Preexcitation Syndromes. In: Benditt, D.G., Benson, D.W. (eds) Cardiac Preexcitation Syndromes. Springer, Boston, MA. https://doi.org/10.1007/978-1-4684-7526-5_3

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  • DOI: https://doi.org/10.1007/978-1-4684-7526-5_3

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4684-7528-9

  • Online ISBN: 978-1-4684-7526-5

  • eBook Packages: Springer Book Archive

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