Ventricular Pre-Excitation Pattern in a Competitive Athlete

BACKGROUND: Ventricular pre-excitation in competitive athletes requires careful evaluation as not all accessory pathways carry equal risk. Fasciculoventricular pathways (FVPs) are a rare, benign subtype that should be distinguished from higher-risk pathways. CASE SUMMARY: A 21-year-old asymptomatic male collegiate cross-country athlete was found to have a ventricular pre-excitation pattern on routine screening electrocardiogram. An electrophysiology study revealed a shortened His-ventricular interval with a fixed pre-excitation pattern during atrial pacing. Intravenous adenosine produced a transient atrioventricular block with a fixed pre-excitation pattern, confirming a benign FVP. No ablation was performed. DISCUSSION: FVPs represent less than 1% of cases of pre-excitation patterns and carry no risk of sudden cardiac death. Ablation is contraindicated (Class III: Harm) because of the risk of complete atrioventricular block. Adenosine testing can noninvasively differentiate FVPs from higher risk pathways. TAKE-HOME MESSAGES: Accurate characterization of accessory pathways is critical. Athletes with FVPs may continue unrestricted sports participation without ablation.