TY - CHAP M1 - Book, Section TI - Accessory Pathways and Preexcitation A1 - Zimmerman, Franklin H. Y1 - 2023 N1 - T2 - ECG Core Curriculum AB - In the normal heart a dense band of fibrous tissue forms early in embryogenesis to anatomically and electrically insulate the atria from the ventricles. The only natural electrical link between the atria and the ventricles is via the AV node and His-Purkinje system. Ventricular preexcitation is said to occur when all or part of the ventricular myocardium is activated by the atrial impulse earlier than would be expected if the stimulus were to reach the ventricles by way of the normal AV conduction system. This premature activation can occur only if there is an alternate route that allows the electrical stimulus to bypass the normal physiologic delay of the AV node. Atrioventricular bypass pathways are embryologic remnants of muscle bundles that bridge the heart’s fibrous skeleton, providing the means for abnormal electrical conduction between the atrium and ventricle (Figure 9-1). Transmission of the electrical impulse over such an accessory pathway produces characteristic findings on the ECG and may provide a substrate for cardiac arrhythmias. SN - PB - McGraw Hill Education CY - New York, NY Y2 - 2024/09/17 UR - accessmedicine.mhmedical.com/content.aspx?aid=1200100195 ER -