Differentials
Atriofascicular pathway
SIGNS / SYMPTOMS
There may be no difference in signs and symptoms in acute presentation with arrhythmias.
INVESTIGATIONS
Baseline ECG normal. On electrophysiologic study, the pathway will be located at right lateral tricuspid annulus to right ventricular apex.
Arrhythmias not seen are: orthodromic atrioventricular re-entry tachycardia (AVRT), atrial fibrillation and flutter, and long RP tachycardia. [Figure caption and citation for the preceding image starts]: Rare forms of accessory pathways occur due to various anatomic substrates with different ECG manifestationsFrom the collection of Dr Mithilesh K. Das [Citation ends].
Lown-Ganong-Levine syndrome
SIGNS / SYMPTOMS
There may be no difference in signs and symptoms in acute presentation with arrhythmias.
INVESTIGATIONS
Baseline ECG shows short PR interval. On electrophysiologic study, there is atrio-nodal bypass or enhanced atrioventricular nodal conduction.
Arrhythmias not seen are: antidromic AVRT, atrial fibrillation and flutter, and long RP tachycardia.
Nodofascicular pathway
SIGNS / SYMPTOMS
There may be no difference in signs and symptoms in acute presentation with arrhythmias.
INVESTIGATIONS
Baseline ECG shows short PR interval, but no delta wave. On electrophysiologic study, there will be a pathway from atrioventricular node to the ventricle.
Arrhythmias not seen are: orthodromic AVRT, antidromic AVRT, atrial fibrillation and flutter, and long RP tachycardia. [Figure caption and citation for the preceding image starts]: Rare forms of accessory pathways occur due to various anatomic substrates with different ECG manifestationsFrom the collection of Dr Mithilesh K. Das [Citation ends].
Fasciculoventricular pathway
SIGNS / SYMPTOMS
There may be no difference in signs and symptoms in acute presentation with arrhythmias.
INVESTIGATIONS
Baseline ECG shows short PR, narrow QRS, and delta wave. On electrophysiologic study, there will be a His bundle or bundle branch to the ventricle.
Arrhythmias not seen are: orthodromic AVRT, antidromic AVRT, atrial fibrillation and flutter, and long RP tachycardia. [Figure caption and citation for the preceding image starts]: Rare forms of accessory pathways occur due to various anatomic substrates with different ECG manifestationsFrom the collection of Dr Mithilesh K. Das [Citation ends].
Other accessory pathways with atypical course
SIGNS / SYMPTOMS
There may be no difference in signs and symptoms in acute presentation with arrhythmias.
INVESTIGATIONS
Baseline ECG shows delta wave. Electrophysiology shows a coronary sinus diverticulum or atrial appendage to ventricle. [Figure caption and citation for the preceding image starts]: Rare forms of accessory pathways occur due to various anatomic substrates with different ECG manifestationsFrom the collection of Dr Mithilesh K. Das [Citation ends].
Use of this content is subject to our disclaimer