Hypertrophic cardiomyopathy with preexcitation: insights from noninvasive electrocardiographic imaging (ECGI) and catheter mapping.
Hypertrophic Cardiomyopathy and Preexcitation.


BACKGROUND
Fasciculoventricular pathway has been described as an unusual variant of preexcitation. Electrocardiographic imaging (ECGI) is a novel imaging modality for noninvasive electroanatomic mapping of epicardial activation and repolarization.


METHODS
We present a case of an 18-year-old male with hypertrophic cardiomyopathy (HCM) and an electrocardiogram (ECG)-based diagnosis of Wolff-Parkinson-White (WPW) syndrome, who underwent a noninvasive ECGI study to image ventricular activation, followed by an electrophysiology study (EPS). The ECGI electroanatomic isochrone map showed early activation of the epicardial aspect of the atrioventricular (A-V) groove and an aberrant posterior-base-to-apex progression of activation in the left ventricular (LV) epicardium. The EPS showed a likely fasciculoventricular pathway (FVP) without any inducible tachycardia.


CONCLUSIONS
While FVP has been described before, this is the first report of detailed quantitative three-dimensional characterization of electrical activation sequence of a heart with this type of preexcitation, using a novel noninvasive imaging modality (ECGI). In spite of abnormal ventricular activation, the EPS demonstrated that the FVP is not capable of supporting reentrant supraventricular tachycardia or rapidly conducted atrial fibrillation.
Ghosh
Subham
S
Cardiac Bioelectricity and Arrhythmia Center, Washington University, St Louis, Missouri 63130-4899, USA.
Avari
Jennifer N
JN
Rhee
Edward K
EK
Woodard
Pamela K
PK
Rudy
Yoram
Y
D000293:Adolescent; D018780:Body Surface Potential Mapping / Q000379:methods*; D006328:Cardiac Catheterization / Q000379:methods*; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis*; D004562:Electrocardiography / Q000379:methods*; D006801:Humans; D008297:Male; D014927:Wolff-Parkinson-White Syndrome / Q000175:diagnosis*