HemoChat

Evidence-Based AI Medical Search

← Back to guidelines
Cardiology210 papers

Concealed accessory pathway

Last edited: 4/22/2026

Overview

Concealed accessory pathways are abnormal electrical connections between the atria and ventricles that do not manifest clinically with overt preexcitation on the surface ECG but can still facilitate arrhythmias.

Diagnosis

  • Electrocardiographic monitoring may not reveal overt preexcitation 1248.
  • Electrophysiological study (EPS) is essential for diagnosis, identifying concealed pathways through retrograde or anterograde conduction testing 1251527.
  • Use of adenosine or ATP can help assess retrograde conduction properties 1725.
  • Para-Hisian pacing can differentiate conduction over accessory pathways from AV node conduction 34.

    • Management

  • First-line Treatment: Radiofrequency catheter ablation is the definitive treatment 161019212733414951.
  • Mapping Techniques: Utilize electroanatomic mapping systems (e.g., Ensite NavX 3D) for precise localization 161221263536.
  • Catheter Type: Irrigated catheters may offer advantages over non-irrigated catheters, though evidence is limited 4.
  • Special Considerations: Transseptal puncture increases radiation exposure; consider alternatives when feasible 2.
  • Epicardial Ablation: For posteroseptal pathways within coronary venous systems, pericardial access may be necessary to avoid coronary artery injury 719.

    • Special Populations

  • Pediatrics: Cryoablation shows lower acute success rates compared to radiofrequency ablation 13.
  • Comorbidities: Patients with mechanical valves or complex coronary venous anatomy require meticulous planning and specialized techniques 816.

    • Key Recommendations

  • Perform electrophysiological study for definitive diagnosis of concealed accessory pathways (Evidence: Moderate 1515).
  • Utilize advanced mapping systems like 3D electroanatomic mapping for precise localization and ablation (Evidence: Moderate 161221263536).
  • Consider radiofrequency catheter ablation as the primary treatment modality due to its efficacy (Evidence: Moderate 161019212733414951).
  • Exercise caution with transseptal puncture due to increased radiation exposure; weigh risks and benefits (Evidence: Moderate 2).
  • For posteroseptal pathways near coronary veins, epicardial access may be required to minimize coronary artery risks (Evidence: Moderate 719).

    • References

    1 Zhang S, Wu Z, Chen M, Li X, Liu Q, Zhou S. Comparison between conventional approach and three-dimensional mapping system in the catheter ablation of accessory pathway associated with coronary sinus diverticulum: A single-center experience. Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc 2024. link 2 Rahman M, Smith G, Johnsrude C, LaPage M, Moore J, Shannon K et al.. Transseptal puncture during catheter ablation associated with higher radiation exposure. Cardiology in the young 2023. link 3 Miyazaki S, Ishikawa E, Mukai M, Aoyama D, Nodera M, Hasegawa K et al.. Ultra-high resolution mapping and ablation of accessory pathway conduction. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing 2021. link 4 Siroky GP, Hazari M, Younan Z, Patel A, Balog J, Rudnick A et al.. Irrigated vs. Non-irrigated Catheters in the Ablation of Accessory Pathways. Journal of cardiovascular translational research 2020. link 5 Li MM, Li JY, Sang CH, Jiang CX, Guo XY, Zhao X et al.. Right free-wall accessory pathway with branched atrial insertions: Clinical, electrocardiographic, and electrophysiological characteristics. Heart rhythm 2020. link 6 Dengke Z, Lan L, Xiangli S, Shubin J. Treatment of left accessory cardiac pathway conduction disorders using radiofrequency catheter ablation under the guidance of the Ensite NavX 3D mapping system: a retrospective study. The international journal of cardiovascular imaging 2019. link 7 Stavrakis S, Jackman WM, Nakagawa H, Sun Y, Xu Q, Beckman KJ et al.. Risk of coronary artery injury with radiofrequency ablation and cryoablation of epicardial posteroseptal accessory pathways within the coronary venous system. Circulation. Arrhythmia and electrophysiology 2014. link 8 Aslani A, Moradi M, Kheirkhah J, Haghjoo M. Catheter ablation of an accessory pathway within the marshall vein in a patient with mechanical mitral valve. Pacing and clinical electrophysiology : PACE 2013. link 9 Orczykowski M, Walczak F, Derejko P, Bodalski R, Urbanek P, Zakrzewska-Koperska J et al.. Ventricular fibrillation risk factors in over one thousand patients with accessory pathways. International journal of cardiology 2013. link 10 Long DY, Dong JZ, Liu XP, Tang RB, Ning M, Gao LY et al.. Ablation of right-sided accessory pathways with atrial insertion far from the tricuspid annulus using an electroanatomical mapping system. Journal of cardiovascular electrophysiology 2011. link 11 Bulava A, Hanis J, Sitek D. Mitral isthmus conduction block: intriguing result of radiofrequency catheter ablation for a left concealed accessory pathway. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 2010. link 12 Fishberger SB, Hernandez A, Zahn EM. Electroanatomic mapping of the right coronary artery: a novel approach to ablation of right free-wall accessory pathways. Journal of cardiovascular electrophysiology 2009. link 13 Kaltman JR, Tanel RE, Wegrzynowicz B, Kozodoy E, Wieand T, Ennis J et al.. Time and temperature profile of catheter cryoablation of right septal and free wall accessory pathways in children. Journal of cardiovascular electrophysiology 2008. link 14 Calò L, Sciarra L, De Ruvo E, Franceschetti R, Pellegrini R, Lioy E. Successful catheter ablation of a manifest left anterior accessory pathway. Journal of cardiovascular medicine (Hagerstown, Md.) 2007. link 15 Akiyama M, Kaneko Y, Taniguchi Y, Nakajima T, Manita M, Ito T et al.. Coronary sinus recordings of double potentials associated with retrograde conduction through left atrioventricular accessory pathways. Journal of cardiovascular electrophysiology 2004. link 16 Boulos M, Gepstein L. Electroanatomical mapping and radiofrequency ablation of an accessory pathway associated with a large aneurysm of the coronary sinus. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 2004. link 17 Alvarez M, Tercedor L, Lozano JM, González-Molina M, Fernández JC, Figueras M et al.. Utility of adenosine 5'-triphosphate in predicting early recurrence after successful ablation of manifest accessory pathways. Heart rhythm 2004. link 18 Shah MJ, Jones TK, Cecchin F. Improved localization of right-sided accessory pathways with microcatheter-assisted right coronary artery mapping in children. Journal of cardiovascular electrophysiology 2004. link 19 Saad EB, Marrouche NF, Cole CR, Natale A. Simultaneous epicardial and endocardial mapping of a left-sided posteroseptal accessory pathway associated with a large coronary sinus diverticulum: successful ablation by transection of the diverticulum's neck. Pacing and clinical electrophysiology : PACE 2002. link 20 Kler TS, Bhatia A, Saxena A, Sardana R, Arora V. Catheter ablation of left free wall accessory pathway in a patient with inferior vena cava interruption. Indian heart journal 2002. link 21 Sapp J, Soejima K, Couper GS, Stevenson WG. Electrophysiology and anatomic characterization of an epicardial accessory pathway. Journal of cardiovascular electrophysiology 2001. link 22 Kozłowski D, Koźluk E, Piatkowska A, Maruszak H, Gawrysiak M, Grzybiak M et al.. The middle cardiac vein as a key for "posteroseptal" space--a morphological point of view. Folia morphologica 2001. link 23 Herweg B, Fisher JD, Ilercil A, Martinez MR, Gross JN, Kim SG et al.. Cardiac memory after radiofrequency ablation of accessory pathways: the post-ablation T wave does not forget the pre-excited QRS. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing 1999. link 24 Basiouny T, de Chillou C, Fareh S, Kirkorian G, Messier M, Sadoul N et al.. Accuracy and limitations of published algorithms using the twelve-lead electrocardiogram to localize overt atrioventricular accessory pathways. Journal of cardiovascular electrophysiology 1999. link 25 Kabell G, Corbisiero R, Miller GD, Fitzgerald TF, Cook JR, Kirchhoffer JB. Effects of adenosine on retrograde refractoriness of accessory atrioventricular connections. The American journal of cardiology 1998. link00406-8) 26 Hirao K, Toshida N, Kawabata M, Motokawa K, Suzuki F, Hiejima K. New diagnostic finding to assess para-Hisian pacing observed in a patient with a permanent form of junctional reciprocating tachycardia. Journal of cardiovascular electrophysiology 1998. link 27 Suyama K, Kurita T, Shimizu W, Matsuo K, Taguchi A, Aihara N et al.. Radiofrequency catheter ablation of concealed atrioventricular accessory pathways using a "simultaneous pacing method". Pacing and clinical electrophysiology : PACE 1998. link 28 Lin JL, Huang SK, Lai LP, Cheng TF, Tseng YZ, Lien WP. Radiofrequency catheter ablation of septal accessory pathways within the triangle of Koch: importance of energy titration testing other than the local electrogram characteristics for identifying the successful target site. Pacing and clinical electrophysiology : PACE 1998. link 29 Schlüter M, Cappato R, Ouyang F, Antz M, Schlüter CA, Kuck KH. Clinical recurrences after successful accessory pathway ablation: the role of "dormant" accessory pathways. Journal of cardiovascular electrophysiology 1997. link 30 Shah DC, Jaïs P, Haïssaguerre M, Takahashi A, Clémenty J. Negative lead I P waves during anteroseptal accessory pathway orthodromic reciprocating tachycardia. The American journal of cardiology 1997. link00329-9) 31 Tai CT, Chen SA, Chiang CE, Lee SH, Wen ZC, Chen YJ et al.. Identification of fiber orientation in left free-wall accessory pathways: implication for radiofrequency ablation. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing 1997. link 32 Suguta M, Nogami A, Naito S, Oshima S, Taniguchi K, Aonuma K et al.. Retrograde supernormal conduction in concealed accessory atrioventricular pathway following catheter ablation. Journal of cardiovascular electrophysiology 1997. link 33 Chen SA, Tai CT, Chiang CE, Lee SH, Wen ZC, Chiou CW et al.. Electrophysiologic characteristics, electropharmacologic responses and radiofrequency ablation in patients with decremental accessory pathway. Journal of the American College of Cardiology 1996. link00219-7) 34 Hirao K, Otomo K, Wang X, Beckman KJ, McClelland JH, Widman L et al.. Para-Hisian pacing. A new method for differentiating retrograde conduction over an accessory AV pathway from conduction over the AV node. Circulation 1996. link 35 Tebbenjohanns J, Pfeiffer D, Schumacher B, Jung W, Manz M, Lüderitz B. Direct angiography of the coronary sinus: impact on left posteroseptal accessory pathway ablation. Pacing and clinical electrophysiology : PACE 1996. link 36 Schumacher B, Tebbenjohanns J, Pfeiffer D, Omran H, Jung W, Lüderitz B. Prospective study of retrograde coronary venography in patients with posteroseptal and left-sided accessory atrioventricular pathways. American heart journal 1995. link90205-8) 37 d'Avila A, Brugada J, Skeberis V, Andries E, Sosa E, Brugada P. A fast and reliable algorithm to localize accessory pathways based on the polarity of the QRS complex on the surface ECG during sinus rhythm. Pacing and clinical electrophysiology : PACE 1995. link 38 Fram DB, Berns E, Aretz T, Gillam LD, Mikan JS, Waters D et al.. Feasibility of radiofrequency powered, thermal balloon ablation of atrioventricular bypass tracts via the coronary sinus: in vivo canine studies. Pacing and clinical electrophysiology : PACE 1995. link 39 Manolis AS, Wang PJ, Estes NA. Radiofrequency ablation of atrial insertion of left-sided accessory pathways guided by the "W Sign". Journal of cardiovascular electrophysiology 1995. link 40 Chen X, Borggrefe M, Martinez-Rubio A, Hief C, Haverkamp W, Hindricks G et al.. Efficacy of ajmaline and propafenone in patients with accessory pathways: a prospective randomized study. Journal of cardiovascular pharmacology 1994. link 41 Manolis AS, Wang PJ, Estes NA. Radiofrequency ablation of left-sided accessory pathways: transaortic versus transseptal approach. American heart journal 1994. link90586-x) 42 Vijgen JM, Carlson MD. Independent ablation of retrograde and anterograde accessory connection conduction at the atrial and ventricular insertion sites: evidence supporting the impedance mismatch hypothesis for unidirectional block. Journal of cardiovascular electrophysiology 1994. link 43 Xie B, Heald SC, Bashir Y, Camm AJ, Ward DE. Radiofrequency catheter ablation of septal accessory atrioventricular pathways. British heart journal 1994. link 44 Cappato R, Schlüter M, Mont L, Kuck KH. Anatomic, electrical, and mechanical factors affecting bipolar endocardial electrograms. Impact on catheter ablation of manifest left free-wall accessory pathways. Circulation 1994. link 45 Haissaguerre M, Marcus F, Poquet F, Gencel L, Le Métayer P, Clémenty J. Electrocardiographic characteristics and catheter ablation of parahissian accessory pathways. Circulation 1994. link 46 Li HG, Morillo CA, Zardini M, Thakur RK, Yee R, Klein GJ. Effect of adenosine or adenosine triphosphate on antidromic tachycardia. Journal of the American College of Cardiology 1994. link90021-3) 47 Li HG, Klein GJ, Yee R, Thakur RK. Fatigue phenomenon in accessory pathways. Journal of cardiovascular electrophysiology 1994. link 48 Rodriguez LM, Smeets JL, de Chillou C, Metzger J, Schläpfer J, Penn O et al.. The 12-lead electrocardiogram in midseptal, anteroseptal, posteroseptal and right free wall accessory pathways. The American journal of cardiology 1993. link90296-o) 49 Lesh MD, Van Hare GF, Scheinman MM, Ports TA, Epstein LA. Comparison of the retrograde and transseptal methods for ablation of left free wall accessory pathways. Journal of the American College of Cardiology 1993. link90062-6) 50 Willems S, Shenasa M, Borggrefe M, Seidl K, Chen X, Hindricks G et al.. Unexpected emergence of manifest preexcitation following transcatheter ablation of concealed accessory pathways. Journal of cardiovascular electrophysiology 1993. link 51 Langberg JJ, Man KC, Vorperian VR, Williamson B, Kalbfleisch SJ, Strickberger SA et al.. Recognition and catheter ablation of subepicardial accessory pathways. Journal of the American College of Cardiology 1993. link90422-w) 52 Bashir Y, Heald SC, O'Nunain S, Katritsis D, Camm AJ, Ward DE. Radiofrequency current delivery by way of a bipolar tricuspid annulus-mitral annulus electrode configuration for ablation of posteroseptal accessory pathways. Journal of the American College of Cardiology 1993. link90063-7) 53 Haissaguerre M, Gaita F, Fischer B, Egloff P, Lemetayer P, Warin JF. Radiofrequency catheter ablation of left lateral accessory pathways via the coronary sinus. Circulation 1992. link 54 Lesh MD, Coggins DL, Ports TA. Coronary air embolism complicating transseptal radiofrequency ablation of left free-wall accessory pathways. Pacing and clinical electrophysiology : PACE 1992. link 55 Teo WS, Guiraudon G, Klein GJ, Leitch JW, Yee R. A unique preexcitation pattern related to an atypical anteroseptal accessory pathway. Pacing and clinical electrophysiology : PACE 1992. link 56 Scheinman MM, Wang YS, Van Hare GF, Lesh MD. Electrocardiographic and electrophysiologic characteristics of anterior, midseptal and right anterior free wall accessory pathways. Journal of the American College of Cardiology 1992. link90381-v) 57 Chen X, Borggrefe M, Shenasa M, Haverkamp W, Hindricks G, Breithardt G. Characteristics of local electrogram predicting successful transcatheter radiofrequency ablation of left-sided accessory pathways. Journal of the American College of Cardiology 1992. link90021-e) 58 Murdock CJ, Leitch JW, Klein GJ, Guiraudon GM, Yee R, Teo WS. Epicardial mapping in patients with "nodoventricular" accessory pathways. The American journal of cardiology 1991. link90745-7) 59 Wellens HJ, Atie J, Penn OC, Gorgels AP, Brugada P, Smeets JL. Diagnosis and treatment of patients with accessory pathways. Cardiology clinics 1990. link 60 Jackman WM, Kuck KH, Naccarelli GV, Carmen L, Pitha J. Radiofrequency current directed across the mitral anulus with a bipolar epicardial-endocardial catheter electrode configuration in dogs. Circulation 1988. link 61 Chang MS, Miles WM, Prystowsky EN. Supernormal conduction in accessory atrioventricular connections. The American journal of cardiology 1987. link91105-2) 62 Kopka L, Bojenko S, Dabrowa R. The influence of the autonomic system upon atrio-ventricular accessory pathways conductive performance. Aviation, space, and environmental medicine 1985. link 63 Henglein D, Gillette PC, Garson A, Porter CJ. Antegrade conduction and AV node function in patients with unidirectional retrograde accessory pathways. American heart journal 1984. link90079-6) 64 Kerr CR, Gallagher JJ, German LD. Changes in ventriculoatrial intervals with bundle branch block aberration during reciprocating tachycardia in patients with accessory atrioventricular pathways. Circulation 1982. link 65 Pritchett EL, Benditt DG, Smith WM, Gallagher JJ. Effect of catheter position on the initiation of atrial echoes with atrial pacing and premature stimulation in patients with accessory pathways. The American journal of cardiology 1978. link90092-9)

    Original source

    1. [1]
      Comparison between conventional approach and three-dimensional mapping system in the catheter ablation of accessory pathway associated with coronary sinus diverticulum: A single-center experience. — Zhang S, Wu Z, Chen M, Li X, Liu Q, Zhou S Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc (2024)
    2. [2]
      Transseptal puncture during catheter ablation associated with higher radiation exposure. — Rahman M, Smith G, Johnsrude C, LaPage M, Moore J, Shannon K et al. Cardiology in the young (2023)
    3. [3]
      Ultra-high resolution mapping and ablation of accessory pathway conduction. — Miyazaki S, Ishikawa E, Mukai M, Aoyama D, Nodera M, Hasegawa K et al. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing (2021)
    4. [4]
      Irrigated vs. Non-irrigated Catheters in the Ablation of Accessory Pathways. — Siroky GP, Hazari M, Younan Z, Patel A, Balog J, Rudnick A et al. Journal of cardiovascular translational research (2020)
    5. [5]
      Right free-wall accessory pathway with branched atrial insertions: Clinical, electrocardiographic, and electrophysiological characteristics. — Li MM, Li JY, Sang CH, Jiang CX, Guo XY, Zhao X et al. Heart rhythm (2020)
    6. [6]
      Treatment of left accessory cardiac pathway conduction disorders using radiofrequency catheter ablation under the guidance of the Ensite NavX 3D mapping system: a retrospective study. — Dengke Z, Lan L, Xiangli S, Shubin J The international journal of cardiovascular imaging (2019)
    7. [7]
      Risk of coronary artery injury with radiofrequency ablation and cryoablation of epicardial posteroseptal accessory pathways within the coronary venous system. — Stavrakis S, Jackman WM, Nakagawa H, Sun Y, Xu Q, Beckman KJ et al. Circulation. Arrhythmia and electrophysiology (2014)
    8. [8]
      Catheter ablation of an accessory pathway within the marshall vein in a patient with mechanical mitral valve. — Aslani A, Moradi M, Kheirkhah J, Haghjoo M Pacing and clinical electrophysiology : PACE (2013)
    9. [9]
      Ventricular fibrillation risk factors in over one thousand patients with accessory pathways. — Orczykowski M, Walczak F, Derejko P, Bodalski R, Urbanek P, Zakrzewska-Koperska J et al. International journal of cardiology (2013)
    10. [10]
      Ablation of right-sided accessory pathways with atrial insertion far from the tricuspid annulus using an electroanatomical mapping system. — Long DY, Dong JZ, Liu XP, Tang RB, Ning M, Gao LY et al. Journal of cardiovascular electrophysiology (2011)
    11. [11]
      Mitral isthmus conduction block: intriguing result of radiofrequency catheter ablation for a left concealed accessory pathway. — Bulava A, Hanis J, Sitek D Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology (2010)
    12. [12]
      Electroanatomic mapping of the right coronary artery: a novel approach to ablation of right free-wall accessory pathways. — Fishberger SB, Hernandez A, Zahn EM Journal of cardiovascular electrophysiology (2009)
    13. [13]
      Time and temperature profile of catheter cryoablation of right septal and free wall accessory pathways in children. — Kaltman JR, Tanel RE, Wegrzynowicz B, Kozodoy E, Wieand T, Ennis J et al. Journal of cardiovascular electrophysiology (2008)
    14. [14]
      Successful catheter ablation of a manifest left anterior accessory pathway. — Calò L, Sciarra L, De Ruvo E, Franceschetti R, Pellegrini R, Lioy E Journal of cardiovascular medicine (Hagerstown, Md.) (2007)
    15. [15]
      Coronary sinus recordings of double potentials associated with retrograde conduction through left atrioventricular accessory pathways. — Akiyama M, Kaneko Y, Taniguchi Y, Nakajima T, Manita M, Ito T et al. Journal of cardiovascular electrophysiology (2004)
    16. [16]
      Electroanatomical mapping and radiofrequency ablation of an accessory pathway associated with a large aneurysm of the coronary sinus. — Boulos M, Gepstein L Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology (2004)
    17. [17]
      Utility of adenosine 5'-triphosphate in predicting early recurrence after successful ablation of manifest accessory pathways. — Alvarez M, Tercedor L, Lozano JM, González-Molina M, Fernández JC, Figueras M et al. Heart rhythm (2004)
    18. [18]
      Improved localization of right-sided accessory pathways with microcatheter-assisted right coronary artery mapping in children. — Shah MJ, Jones TK, Cecchin F Journal of cardiovascular electrophysiology (2004)
    19. [19]
      Simultaneous epicardial and endocardial mapping of a left-sided posteroseptal accessory pathway associated with a large coronary sinus diverticulum: successful ablation by transection of the diverticulum's neck. — Saad EB, Marrouche NF, Cole CR, Natale A Pacing and clinical electrophysiology : PACE (2002)
    20. [20]
      Catheter ablation of left free wall accessory pathway in a patient with inferior vena cava interruption. — Kler TS, Bhatia A, Saxena A, Sardana R, Arora V Indian heart journal (2002)
    21. [21]
      Electrophysiology and anatomic characterization of an epicardial accessory pathway. — Sapp J, Soejima K, Couper GS, Stevenson WG Journal of cardiovascular electrophysiology (2001)
    22. [22]
      The middle cardiac vein as a key for "posteroseptal" space--a morphological point of view. — Kozłowski D, Koźluk E, Piatkowska A, Maruszak H, Gawrysiak M, Grzybiak M et al. Folia morphologica (2001)
    23. [23]
      Cardiac memory after radiofrequency ablation of accessory pathways: the post-ablation T wave does not forget the pre-excited QRS. — Herweg B, Fisher JD, Ilercil A, Martinez MR, Gross JN, Kim SG et al. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing (1999)
    24. [24]
      Accuracy and limitations of published algorithms using the twelve-lead electrocardiogram to localize overt atrioventricular accessory pathways. — Basiouny T, de Chillou C, Fareh S, Kirkorian G, Messier M, Sadoul N et al. Journal of cardiovascular electrophysiology (1999)
    25. [25]
      Effects of adenosine on retrograde refractoriness of accessory atrioventricular connections. — Kabell G, Corbisiero R, Miller GD, Fitzgerald TF, Cook JR, Kirchhoffer JB The American journal of cardiology (1998)
    26. [26]
      New diagnostic finding to assess para-Hisian pacing observed in a patient with a permanent form of junctional reciprocating tachycardia. — Hirao K, Toshida N, Kawabata M, Motokawa K, Suzuki F, Hiejima K Journal of cardiovascular electrophysiology (1998)
    27. [27]
      Radiofrequency catheter ablation of concealed atrioventricular accessory pathways using a "simultaneous pacing method". — Suyama K, Kurita T, Shimizu W, Matsuo K, Taguchi A, Aihara N et al. Pacing and clinical electrophysiology : PACE (1998)
    28. [28]
      Radiofrequency catheter ablation of septal accessory pathways within the triangle of Koch: importance of energy titration testing other than the local electrogram characteristics for identifying the successful target site. — Lin JL, Huang SK, Lai LP, Cheng TF, Tseng YZ, Lien WP Pacing and clinical electrophysiology : PACE (1998)
    29. [29]
      Clinical recurrences after successful accessory pathway ablation: the role of "dormant" accessory pathways. — Schlüter M, Cappato R, Ouyang F, Antz M, Schlüter CA, Kuck KH Journal of cardiovascular electrophysiology (1997)
    30. [30]
      Negative lead I P waves during anteroseptal accessory pathway orthodromic reciprocating tachycardia. — Shah DC, Jaïs P, Haïssaguerre M, Takahashi A, Clémenty J The American journal of cardiology (1997)
    31. [31]
      Identification of fiber orientation in left free-wall accessory pathways: implication for radiofrequency ablation. — Tai CT, Chen SA, Chiang CE, Lee SH, Wen ZC, Chen YJ et al. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing (1997)
    32. [32]
      Retrograde supernormal conduction in concealed accessory atrioventricular pathway following catheter ablation. — Suguta M, Nogami A, Naito S, Oshima S, Taniguchi K, Aonuma K et al. Journal of cardiovascular electrophysiology (1997)
    33. [33]
      Electrophysiologic characteristics, electropharmacologic responses and radiofrequency ablation in patients with decremental accessory pathway. — Chen SA, Tai CT, Chiang CE, Lee SH, Wen ZC, Chiou CW et al. Journal of the American College of Cardiology (1996)
    34. [34]
      Para-Hisian pacing. A new method for differentiating retrograde conduction over an accessory AV pathway from conduction over the AV node. — Hirao K, Otomo K, Wang X, Beckman KJ, McClelland JH, Widman L et al. Circulation (1996)
    35. [35]
      Direct angiography of the coronary sinus: impact on left posteroseptal accessory pathway ablation. — Tebbenjohanns J, Pfeiffer D, Schumacher B, Jung W, Manz M, Lüderitz B Pacing and clinical electrophysiology : PACE (1996)
    36. [36]
      Prospective study of retrograde coronary venography in patients with posteroseptal and left-sided accessory atrioventricular pathways. — Schumacher B, Tebbenjohanns J, Pfeiffer D, Omran H, Jung W, Lüderitz B American heart journal (1995)
    37. [37]
      A fast and reliable algorithm to localize accessory pathways based on the polarity of the QRS complex on the surface ECG during sinus rhythm. — d'Avila A, Brugada J, Skeberis V, Andries E, Sosa E, Brugada P Pacing and clinical electrophysiology : PACE (1995)
    38. [38]
      Feasibility of radiofrequency powered, thermal balloon ablation of atrioventricular bypass tracts via the coronary sinus: in vivo canine studies. — Fram DB, Berns E, Aretz T, Gillam LD, Mikan JS, Waters D et al. Pacing and clinical electrophysiology : PACE (1995)
    39. [39]
      Radiofrequency ablation of atrial insertion of left-sided accessory pathways guided by the "W Sign". — Manolis AS, Wang PJ, Estes NA Journal of cardiovascular electrophysiology (1995)
    40. [40]
      Efficacy of ajmaline and propafenone in patients with accessory pathways: a prospective randomized study. — Chen X, Borggrefe M, Martinez-Rubio A, Hief C, Haverkamp W, Hindricks G et al. Journal of cardiovascular pharmacology (1994)
    41. [41]
      Radiofrequency ablation of left-sided accessory pathways: transaortic versus transseptal approach. — Manolis AS, Wang PJ, Estes NA American heart journal (1994)
    42. [42]
      Independent ablation of retrograde and anterograde accessory connection conduction at the atrial and ventricular insertion sites: evidence supporting the impedance mismatch hypothesis for unidirectional block. — Vijgen JM, Carlson MD Journal of cardiovascular electrophysiology (1994)
    43. [43]
      Radiofrequency catheter ablation of septal accessory atrioventricular pathways. — Xie B, Heald SC, Bashir Y, Camm AJ, Ward DE British heart journal (1994)
    44. [44]
      Anatomic, electrical, and mechanical factors affecting bipolar endocardial electrograms. Impact on catheter ablation of manifest left free-wall accessory pathways. — Cappato R, Schlüter M, Mont L, Kuck KH Circulation (1994)
    45. [45]
      Electrocardiographic characteristics and catheter ablation of parahissian accessory pathways. — Haissaguerre M, Marcus F, Poquet F, Gencel L, Le Métayer P, Clémenty J Circulation (1994)
    46. [46]
      Effect of adenosine or adenosine triphosphate on antidromic tachycardia. — Li HG, Morillo CA, Zardini M, Thakur RK, Yee R, Klein GJ Journal of the American College of Cardiology (1994)
    47. [47]
      Fatigue phenomenon in accessory pathways. — Li HG, Klein GJ, Yee R, Thakur RK Journal of cardiovascular electrophysiology (1994)
    48. [48]
      The 12-lead electrocardiogram in midseptal, anteroseptal, posteroseptal and right free wall accessory pathways. — Rodriguez LM, Smeets JL, de Chillou C, Metzger J, Schläpfer J, Penn O et al. The American journal of cardiology (1993)
    49. [49]
      Comparison of the retrograde and transseptal methods for ablation of left free wall accessory pathways. — Lesh MD, Van Hare GF, Scheinman MM, Ports TA, Epstein LA Journal of the American College of Cardiology (1993)
    50. [50]
      Unexpected emergence of manifest preexcitation following transcatheter ablation of concealed accessory pathways. — Willems S, Shenasa M, Borggrefe M, Seidl K, Chen X, Hindricks G et al. Journal of cardiovascular electrophysiology (1993)
    51. [51]
      Recognition and catheter ablation of subepicardial accessory pathways. — Langberg JJ, Man KC, Vorperian VR, Williamson B, Kalbfleisch SJ, Strickberger SA et al. Journal of the American College of Cardiology (1993)
    52. [52]
      Radiofrequency current delivery by way of a bipolar tricuspid annulus-mitral annulus electrode configuration for ablation of posteroseptal accessory pathways. — Bashir Y, Heald SC, O'Nunain S, Katritsis D, Camm AJ, Ward DE Journal of the American College of Cardiology (1993)
    53. [53]
      Radiofrequency catheter ablation of left lateral accessory pathways via the coronary sinus. — Haissaguerre M, Gaita F, Fischer B, Egloff P, Lemetayer P, Warin JF Circulation (1992)
    54. [54]
      Coronary air embolism complicating transseptal radiofrequency ablation of left free-wall accessory pathways. — Lesh MD, Coggins DL, Ports TA Pacing and clinical electrophysiology : PACE (1992)
    55. [55]
      A unique preexcitation pattern related to an atypical anteroseptal accessory pathway. — Teo WS, Guiraudon G, Klein GJ, Leitch JW, Yee R Pacing and clinical electrophysiology : PACE (1992)
    56. [56]
      Electrocardiographic and electrophysiologic characteristics of anterior, midseptal and right anterior free wall accessory pathways. — Scheinman MM, Wang YS, Van Hare GF, Lesh MD Journal of the American College of Cardiology (1992)
    57. [57]
      Characteristics of local electrogram predicting successful transcatheter radiofrequency ablation of left-sided accessory pathways. — Chen X, Borggrefe M, Shenasa M, Haverkamp W, Hindricks G, Breithardt G Journal of the American College of Cardiology (1992)
    58. [58]
      Epicardial mapping in patients with "nodoventricular" accessory pathways. — Murdock CJ, Leitch JW, Klein GJ, Guiraudon GM, Yee R, Teo WS The American journal of cardiology (1991)
    59. [59]
      Diagnosis and treatment of patients with accessory pathways. — Wellens HJ, Atie J, Penn OC, Gorgels AP, Brugada P, Smeets JL Cardiology clinics (1990)
    60. [60]
      Radiofrequency current directed across the mitral anulus with a bipolar epicardial-endocardial catheter electrode configuration in dogs. — Jackman WM, Kuck KH, Naccarelli GV, Carmen L, Pitha J Circulation (1988)
    61. [61]
      Supernormal conduction in accessory atrioventricular connections. — Chang MS, Miles WM, Prystowsky EN The American journal of cardiology (1987)
    62. [62]
      The influence of the autonomic system upon atrio-ventricular accessory pathways conductive performance. — Kopka L, Bojenko S, Dabrowa R Aviation, space, and environmental medicine (1985)
    63. [63]
      Antegrade conduction and AV node function in patients with unidirectional retrograde accessory pathways. — Henglein D, Gillette PC, Garson A, Porter CJ American heart journal (1984)
    64. [64]
      Changes in ventriculoatrial intervals with bundle branch block aberration during reciprocating tachycardia in patients with accessory atrioventricular pathways. — Kerr CR, Gallagher JJ, German LD Circulation (1982)
    65. [65]
      Effect of catheter position on the initiation of atrial echoes with atrial pacing and premature stimulation in patients with accessory pathways. — Pritchett EL, Benditt DG, Smith WM, Gallagher JJ The American journal of cardiology (1978)
    Share:TwitterRedditLinkedIn

    HemoChat

    by SPINAI

    Evidence-based clinical decision support powered by SNOMED-CT, Neo4j GraphRAG, and NASS/AO/NICE guidelines.

    ⚕ For clinical reference only. Not a substitute for professional judgment.

    © 2026 HemoChat. All rights reserved.
    Research·Pricing·Privacy & Terms·Refund·SNOMED-CT · NASS · AO Spine · NICE · GraphRAG