This issue, the fourth consecutive publication edited by our group, follows "Reinterpreting the Basic ECG," "Clinical Aspects of Arrhythmias," and, last year, "The Rational Approach to Complex Arrhythmias." This year the topic is ventricular preexcitation, which we have reviewed within the optic of "Precision Electrocardiology," the method of electrocardiogram (ECG) interpretation that has been the common thread for all the previous issues. Ventricular preexcitation, with its multifaceted electrocardiographic expressions, is indeed a natural marvel potentially encompassing every elec-trophysiologic principle. A normal conducting system in parallel with an accessory atrioventricular pathway both activated almost simultaneously but, at the same time, competing to activate the ventricles. From an unusual ECG in sinus rhythm, clearly demonstrating this competition, to a sudden covenant where the 2 conducting systems are joined by ventricles and atria in a macro-reentrant circuit. A sudden inversion of the direction of propagation can dramatically change the ECG appearance, requiring uncommon skills and knowledge for its immediate identification!
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