Detection of a Local Slow Potential Preceding the Surface QRS Complex During Non-Preexcited Impulse Propagation : A Phenomenon Reflecting Anterograde Concealed Conduction Through the Accessory Pathway?

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A case of Wolff-Parkinson-White(WPW)syndrome with several interesting electrophysiologic findings is presented. Although manifest preexcitation had not been documented in clinical routine check-ups for the 2 years before the ablation session, an intermittent preexcitation emerged after an initial unsuccessful radiofrequency current delivery directed at the subvalvular mitral annulus 1 cm distal from the subsequent successful ablation site. During intermittent manifestation of preexcitation, the following observations were made : (1)during manifest preexcitation, a possible Kent potential was recorded at the successful ablation site ; (2)during non-preexcited impulse propagation, a local slow potential preceding the QRS complex(pre-QRS potential)was clearly observed at the same site ; (3)the pre-QRS potential disappeared during orthodromic atrioventricular reciprocating tachycardia, spontaneous atrial premature contraction and after the subsequent successful ablation ; and (4)when the pre-QRS potential was obvious, a small change in QRS morphology of the body-surface ECG was appreciable, compared with that during beats of negative pre-QRS potential. A comparable preceding component was also detected in a signal-averaged ECG. It is considered that the pre-QRS potential might be related to the anterograde concealed conduction through the accessory pathway.
社団法人日本循環器学会の論文
1998-09-20