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Circulation, Vol 61, 1249-1256, Copyright © 1980 by American Heart Association

ARTICLES

Anatomic substrate of impaired antegrade conduction over an accessory atrioventricular pathway in the Wolff-Parkinson-White syndrome

GJ Klein, DB Hackel and JJ Gallagher

We present a patient with Wolff-Parkinson-White syndrome who died of a myocardial infarction 19 months after clinical electrophysiologic studies. These studies suggested the presence of a left atrioventricular accessory pathway that sustained conduction well in the retrograde direction but only intermittently in the antegrade direction. Postmortem examination of the heart revealed three accessory atrioventricular pathways in proximity to each other in the posterolateral atrioventricular region. One pathway showed complete fibrosis and two showed patchy fibrosis. The fibrosis suggests an anatomic basis for the impaired antegrade conduction observed in life.

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