Preexcitation syndrome: experimental study on the electrocardiogram of antegradely conducting accessory pathway

Abstract

Background

Preexcitation syndrome is characterized by a dominant delta wave on the baseline electrocardiogram (ECG), resulting from the change in QRS initial vector by the accessory pathway (AP). This study is to explore the effect of ventricular preexcitation on the QRS initial, maximal and terminal vector in an experimental rabbit with preexcitation syndrome induced by programmed electrical stimulation.

Methods

Rabbits ( n = 10) were randomized for the experimental model of ventricular preexcitation. Sensing and stimulating electrode catheters were placed in the high right atrium and along epicardial surface of atrioventricular groove of the left ventricular anterior wall, respectively. Programmed premature stimulation S ₂ was synchronized with P wave and utilized to stimulate the ventricle. The ECG recorded the electrical activity of the heart. As compared with the QRS complex during sinus rhythm, paced QRS was assessed regarding the initial, maximal and terminal vector. PS ₂ interval and PR interval were also measured and analyzed.

Results

Preexcitation was successfully simulated by ventricular pacing in the rabbits, including (1) Complete preexcitation: PS ₂ interval was less than PR interval; the difference was more than or equal to 47.00 ± 7.53 ms. (2) Incomplete preexcitation: PS ₂ interval was less than PR interval; the difference was less than 47.00 ± 7.53 ms. (3) Incomplete latent preexcitation: PS ₂ interval was more than or equal to PR interval; the difference was less than or equal to 13.00 ± 3.50 ms. (4) Complete latent preexcitation: PS ₂ interval was more than or equal to PR interval; the difference was more than 13.00 ± 3.50 ms.

Conclusions

The difference in the relative conduction velocity of the atrioventricular node versus the AP pathways determines the degree of preexcitation and different manifestation on ECG. The QRS terminal vector also reflects the ventricle preexcitation, indicating a valuable sign for the diagnosis of atypical or latent preexcitation.