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In three patients with a Wolff, Parkinson, White (WPW) pattern and systolic murmur, the murmur disappeared or decreased in intensity when the WPW pattern disappeared or became less pronounced. The accentuation of the murmur of tricuspid and mitral insufficiency suggests that pre-excitation may be responsible for an increase in regurgitant flow in patients with these lesions. A “functional” murmur may appear only during pre-excitation. The appearance or increased intensity of the murmur is presumably related to the altered patterns of ventricular activation and contraction accompanying the WPW pattern.

Pre-Excitation as a Cause of Appearance and Increased Intensity of Systolic Murmurs