{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:19:34Z","timestamp":1787008774710,"version":"build-2736575974"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2022,1,6]],"date-time":"2022-01-06T00:00:00Z","timestamp":1641427200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,4,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Surgeons, when dividing bypass tracts adjacent to the His bundle, considered them to be \u2018anteroseptal\u2019. The area was subsequently recognized to be superior and paraseptal, although this description is not entirely accurate anatomically, and conveys little about the potential risk during catheter interventions. We now describe the area as being para-Hisian, and it harbours two types of accessory pathways. The first variant crosses the membranous septum to insert into the muscular ventricular septum without exiting the heart, and hence being truly septal. The second variant inserts distally in the paraseptal components of the supraventricular crest, and consequently is crestal. The site of ventricular insertion determines the electrocardiographic expression of pre-excitation during sinus rhythm, with the two types producing distinct patterns. In both instances, the QRS and the delta wave are positive in leads I, II, and aVF. In crestal pathways, however, the QRS is \u2265 140 ms, and exhibits an rS configuration in V1\u20132. The delta wave in V1\u20132 precedes by 20\u201350 ms the apparent onset of the QRS in I, II, III, and aVF. In the true septal pathways, the QRS complex occupies \u223c120 ms, presenting a QS, W-shaped, morphology in V1\u20132. The delta wave has a simultaneous onset in all leads. Our proposed terminology facilitates the understanding of the electrocardiographic manifestations of both types of para-Hisian pathways during pre-excitation and orthodromic tachycardia, and informs on the level of risk during catheter ablation.<\/jats:p>","DOI":"10.1093\/europace\/euab293","type":"journal-article","created":{"date-parts":[[2021,11,8]],"date-time":"2021-11-08T23:10:23Z","timestamp":1636413023000},"page":"650-661","source":"Crossref","is-referenced-by-count":13,"title":["Miniseries 2\u2014Septal and paraseptal accessory pathways\u2014Part II: Para-Hisian accessory pathways\u2014so-called anteroseptal pathways revisited"],"prefix":"10.1093","volume":"24","author":[{"given":"Jer\u00f3nimo","family":"Farr\u00e9","sequence":"first","affiliation":[{"name":"Fundaci\u00f3n Jim\u00e9nez D\u00edaz University Hospital, Institute of Biomedical Research, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5163-9021","authenticated-orcid":false,"given":"Robert H","family":"Anderson","sequence":"additional","affiliation":[{"name":"Institute of Biosciences, Newcastle University, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dami\u00e1n","family":"S\u00e1nchez-Quintana","sequence":"additional","affiliation":[{"name":"Department of Anatomy and Cell Biology, Universidad de Extremadura, Badajoz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5803-7135","authenticated-orcid":false,"given":"Shumpei","family":"Mori","sequence":"additional","affiliation":[{"name":"UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9-Manuel","family":"Rubio","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Jim\u00e9nez D\u00edaz University Hospital, Institute of Biomedical Research, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camila","family":"Garc\u00eda-Talavera","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Jim\u00e9nez D\u00edaz University Hospital, Institute of Biomedical Research, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1649-8013","authenticated-orcid":false,"given":"Raghav","family":"Bansal","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences (AIIMS), New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yash","family":"Lokhandwala","sequence":"additional","affiliation":[{"name":"Arrhythmia Associates, Mumbai, 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