Anatomic Findings in a Case of Ventricular Pre-Excitation (WPW) Terminating in Complete Atrioventricular Block

Abstract

Electrocardiographic and detailed hlstological studies are presented of a case of ventricular pre-excltatlon with progressive A-V and intraventrlcular block terminating in complete A-V dissociation. Whereas the demonstration of a tract which leads from the atrial septal musculature to the A-V bundle bypassing the A-V node explains the short P-R interval, the delta wave is accounted for by the demonstration of unusually copious Mahalm fibers from the A-V bundle to the posterior portion of the muscular ventricular septum. Thus, this appears to be the first demonstration of Mahaim fibers responsible for A-V transmission in the pre-excitation syndrome. The correlation of the data permitted reconstruction of anatomic changes preceding, and responsible for, the gradual progression of the atrioventricular and intraventrlcular conduction disorder. On the basis of this correlation It would appear that the 2 characteristic criteria of ventricular pre-excitation, shortened P-R and the delta wave, may in some cases have a different anatomic background. A separation of these parameters permits an explanation of certain atypical and puzzling aspects encountered in the syndrome of ventricular pre-excitation and related conditions.