Anatomic findings in a case of ventricular pre-excitation (WPW) terminating in complete atrioventricular block.

VENTRICULAR pre-excitation (WPW syndrome) which becomes associated with atrioventricular block (A-V) sometime in its course is rare. The literature of this combination up to 1959 was reviewed by Moret and associates.' Cases have been reported by Feldmann and Koch,2 Segers and associates,3 Coelho,4 Levine and Burge,j Rodstein, Fox and associates,7 Scherf and associates,8 Pick and Katz,9 Zuckermann,10 Fox," Grant and associates,12 Le Damany and Gouffalt,13 Pick and Fisch,14 and Wolff.15 Recently we were able to follow such a case, with fatal outcome, clinically and in serial electrocardiograms, and had the opportunity of studying both A-V junctions and the conduction system by serial sections of the heart. To our knowledge this is the only case of WPW syndrome terminating in heart block so studied. Previously Levine and Burge5 had studied part of the right A-V groove by serial section, but not the conduction system in such a case. Correlation of electrocardiographic and anatomic findings led us to certain conclusions bearing on the anatomic background of the pre-excitation syndrome and some of its variations.