抄録
Clinical Presentation: Fourty five year old lady presented with recurrent palpitations. She was hypertensive on calcium channel blocker. ECG showed Preexcited sinus rhythm (WPW pattern). The delta wave suggestive of AS pathway. No documented tachycardia was available. Echo showed structurally normal heart. Since presence of H/O palpitation and preexcitation in ECG patient was taken up for EP study and possible ablation. Summary and Conclusion: Baseline ECG showed preexcitation suggestive of AS pathway. No documented tachycardia episode. EP study showed HV 31 msec suggest preexcitation. On A pacing no increase in preexcitation suggestive of fasciculoventricular pathway. On V pacing VA conduction was concentric and decremental indicate retrograde conduction through AV node. On burst atrial pacing Atrial Flutter induced without increase in preexcitation in conducted atrial beats. On IV Adenosine progressive AH prolongation present but without increase in Preexcitation followed by AV block which prooves pathway attached below AV node confirm Fasciculoventricular pathway. Fixed preexcitation proved. Since this pathway was not involved in any tachycardia, so no need to ablate. In the absence of no involvement in tachycardia mechanism inadvertent attempt to ablate may lead to CHB.
