title: Variable clinical features and ablation of manifest nodofascicular/ventricular pathways.
abstract: BACKGROUND
  Manifest nodofascicular/ventricular (NFV) pathways are rare.
  
  
  RESULTS
  From 2008 to 2013, 4 cases were identified with manifest NFV pathways from 3 centers. The clinical findings and ablation sites are reported. All 4 cases presented with a wide complex tachycardia but with different QRS morphologies. Case 1 showed a left bundle branch block/superior axis, case 2 showed a right bundle branch block/inferior axis, case 3 showed a left bundle branch block/inferior axis, and case 4 showed a narrow QRS tachycardia and a wide complex tachycardia with a left bundle branch block/inferior axis. Three of the 4 tachycardias had atrioventricular dissociation ruling out extranodal accessory pathways, including atriofascicular pathways. Programmed extrastimuli showed evidence of a decremental accessory pathway in 3 of the 4 cases. Coexisting tachycardia mechanisms were seen in 3 of the 4 cases (atrioventricular nodal reentry tachycardia [2] and atrioventricular reentrant tachycardia [1]). Ablation in the slow pathway region eliminated the NFV pathway in 3 (transient in 1) with the other responding to surgical closure of a large atrial septal defect. The NFV pathway was a critical part of the tachycardia circuit in 1 and proved to be a bystander in the other 3 cases.
  
  
  CONCLUSIONS
  Manifest NFV pathways presented with variable QRS expression dependent on the ventricular insertion site and often coexisted with other tachycardia mechanisms (atrioventricular nodal reentry tachycardia and atrioventricular reentrant tachycardia). In most cases, the atrial insertion of the pathway was in or near the slow pathway region. The NFV pathways were either critical to the tachycardia circuit or served as bystanders.
authors.affiliation: From the Division of Cardiovascular Medicine, Section of Electrophysiology, University of Wisconsin, Madison (K.S.H.); Division of Cardiovascular Medicine, Section of Electrophysiology, University of California, San Francisco (B.K.L., V.V., M.M.S.); Division of Cardiovascular Medicine, Department of Medicine, Harrington Heart Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (I.T.C., J.A.M., J.S.); Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston (A.A.B.); and Virginia Mason Medical Center, Seattle, WA (R.W.R.).
authors.forename: Kurt S
authors.initials: KS
authors.lastname: Hoffmayer
authors.affiliation: From the Division of Cardiovascular Medicine, Section of Electrophysiology, University of Wisconsin, Madison (K.S.H.); Division of Cardiovascular Medicine, Section of Electrophysiology, University of California, San Francisco (B.K.L., V.V., M.M.S.); Division of Cardiovascular Medicine, Department of Medicine, Harrington Heart Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (I.T.C., J.A.M., J.S.); Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston (A.A.B.); and Virginia Mason Medical Center, Seattle, WA (R.W.R.).
authors.forename: Byron K
authors.initials: BK
authors.lastname: Lee
authors.affiliation: From the Division of Cardiovascular Medicine, Section of Electrophysiology, University of Wisconsin, Madison (K.S.H.); Division of Cardiovascular Medicine, Section of Electrophysiology, University of California, San Francisco (B.K.L., V.V., M.M.S.); Division of Cardiovascular Medicine, Department of Medicine, Harrington Heart Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (I.T.C., J.A.M., J.S.); Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston (A.A.B.); and Virginia Mason Medical Center, Seattle, WA (R.W.R.).
authors.forename: Vasanth
authors.initials: V
authors.lastname: Vedantham
authors.affiliation: From the Division of Cardiovascular Medicine, Section of Electrophysiology, University of Wisconsin, Madison (K.S.H.); Division of Cardiovascular Medicine, Section of Electrophysiology, University of California, San Francisco (B.K.L., V.V., M.M.S.); Division of Cardiovascular Medicine, Department of Medicine, Harrington Heart Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (I.T.C., J.A.M., J.S.); Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston (A.A.B.); and Virginia Mason Medical Center, Seattle, WA (R.W.R.).
authors.forename: Ashish A
authors.initials: AA
authors.lastname: Bhimani
authors.affiliation: From the Division of Cardiovascular Medicine, Section of Electrophysiology, University of Wisconsin, Madison (K.S.H.); Division of Cardiovascular Medicine, Section of Electrophysiology, University of California, San Francisco (B.K.L., V.V., M.M.S.); Division of Cardiovascular Medicine, Department of Medicine, Harrington Heart Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (I.T.C., J.A.M., J.S.); Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston (A.A.B.); and Virginia Mason Medical Center, Seattle, WA (R.W.R.).
authors.forename: Ivan T
authors.initials: IT
authors.lastname: Cakulev
authors.affiliation: From the Division of Cardiovascular Medicine, Section of Electrophysiology, University of Wisconsin, Madison (K.S.H.); Division of Cardiovascular Medicine, Section of Electrophysiology, University of California, San Francisco (B.K.L., V.V., M.M.S.); Division of Cardiovascular Medicine, Department of Medicine, Harrington Heart Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (I.T.C., J.A.M., J.S.); Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston (A.A.B.); and Virginia Mason Medical Center, Seattle, WA (R.W.R.).
authors.forename: Judith A
authors.initials: JA
authors.lastname: Mackall
authors.affiliation: From the Division of Cardiovascular Medicine, Section of Electrophysiology, University of Wisconsin, Madison (K.S.H.); Division of Cardiovascular Medicine, Section of Electrophysiology, University of California, San Francisco (B.K.L., V.V., M.M.S.); Division of Cardiovascular Medicine, Department of Medicine, Harrington Heart Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (I.T.C., J.A.M., J.S.); Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston (A.A.B.); and Virginia Mason Medical Center, Seattle, WA (R.W.R.).
authors.forename: Jayakumar
authors.initials: J
authors.lastname: Sahadevan
authors.affiliation: From the Division of Cardiovascular Medicine, Section of Electrophysiology, University of Wisconsin, Madison (K.S.H.); Division of Cardiovascular Medicine, Section of Electrophysiology, University of California, San Francisco (B.K.L., V.V., M.M.S.); Division of Cardiovascular Medicine, Department of Medicine, Harrington Heart Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (I.T.C., J.A.M., J.S.); Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston (A.A.B.); and Virginia Mason Medical Center, Seattle, WA (R.W.R.).
authors.forename: Robert W
authors.initials: RW
authors.lastname: Rho
authors.affiliation: From the Division of Cardiovascular Medicine, Section of Electrophysiology, University of Wisconsin, Madison (K.S.H.); Division of Cardiovascular Medicine, Section of Electrophysiology, University of California, San Francisco (B.K.L., V.V., M.M.S.); Division of Cardiovascular Medicine, Department of Medicine, Harrington Heart Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (I.T.C., J.A.M., J.S.); Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston (A.A.B.); and Virginia Mason Medical Center, Seattle, WA (R.W.R.). scheinman@medicine.ucsf.edu.
authors.forename: Melvin M
authors.initials: MM
authors.lastname: Scheinman
mesh_terms: D058606:Accessory Atrioventricular Bundle / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D000368:Aged; D017115:Catheter Ablation; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D006327:Heart Block / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
keywords: catheter ablation; electrophysiology; tachycardia, supraventricular