Aberrant ventricular conduction

Short episodes of aberrant ventricular conduction and ventricular tachycardia occurred in three of 32... 

May be difficult to distinguish PVCs from aberrant ventricular conduction. 

May follow an abnormal conduction pathway, giving abnormal appearance to QRS complex and known as aberrancy or aberrant ventricular conduction. 

Ventricular aberrancy, or aberrant ventricular conduction, occurs when an impulse originating in the sinoatrial node, atria, or atrioventricular junction is temporarily conducted abnormally through the bundle branches. The abnormal conduction results in a bundle-branch block, usually because electrical impulses arrive at the bundle branches before the branches have been sufficiently repolarized. 

This occurs in otherwise healthy individuals, who possess an anomalous (accessory) atrioventricular pathway they often experience attacks of paroxj mal AV re-entrant tachycardia or atrial fibrillation. Drugs that both suppress the initiating ectopic beats and delay conduction through the accessory pathway are used to prevent attacks e.g. flecainide, sotalol or amiodarone. Verapamil and digoxin may increase conduction through the anomalous pathway and should not be used. Electrical conversion may be needed to restore sinus rhythm when the ventricular rate is very rapid. Radiofrequency ablation of aberrant pathways will almost certainly provide a cure. 

Problems can also occur in patients with aberrant conduction pathways for example, verapamil caused an increased ventricular response in patients with Wolff-Parkinson-White syndrome associated with atrial fibrillation (9-11). The danger lies in provocation of ventricular fibrillation from advanced anterograde conduction in accessory pathways (12). 

The importance of recognizing aberrantly conducted beats is mainly to prevent misdiagnosis and mistaken treatment of ventricular ectopy. 

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