Seipel L, Ostermeyer J, Abendroth R R, Bircks W, Breithardt G, Gleichmann U
Z Kardiol. 1980 Sep;69(9):593-8.
In a patient with a WPW syndrome, the electrophysiological investigation revealed a left-sided bypass conducting only in antegrade (A-V) direction. During right ventricular stimulation, there was a complete retrograde (V-A) block. Therefore no reentry tachycardia could be initiated. The patient was operated upon because of an aortic valve lesion. During operation the bypass was localized at the free wall of the mitral annulus by epicardial mapping. Even during direct stimulation at the ventricular insertion of the bypass, no retrograde conduction to the left atrium could be demonstrated. After ablation of the bypass by surgery, intra- and postoperative electrophysiological studies showed a normal antegrade activation pattern of the ventricles. The case reported demonstrates that the "heterodromia" of an accessory bypass can markedly influence the clinical setting in the WPW syndrome.
在一名预激综合征患者中，电生理检查显示左侧旁路仅在顺行（房室）方向传导。右心室刺激时，存在完全性逆行（室房）阻滞。因此无法诱发折返性心动过速。该患者因主动脉瓣病变接受手术。手术过程中，通过心外膜标测将旁路定位在二尖瓣环游离壁。即使在旁路心室端直接刺激时，也未显示有向左心房的逆行传导。手术切除旁路后，术中和术后的电生理研究显示心室顺行激动模式正常。报道的该病例表明，旁路的“折返方式”可显著影响预激综合征的临床情况。
