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Cardiac Electrophysiology Clinics Dec 2020
Topics: Electrocardiography; Humans; Pre-Excitation Syndromes
PubMed: 33162006
DOI: 10.1016/j.ccep.2020.09.002 -
Current Problems in Cardiology Mar 2016The classic electrocardiogram in Wolff-Parkinson-White (WPW) syndrome is characterized by a short PR interval and prolonged QRS duration in the presence of sinus rhythm... (Review)
Review
The classic electrocardiogram in Wolff-Parkinson-White (WPW) syndrome is characterized by a short PR interval and prolonged QRS duration in the presence of sinus rhythm with initial slurring. The clinical syndrome associated with above electrocardiogram finding and the history of paroxysmal supraventricular tachycardia is referred to as Wolff-Parkinson-White syndrome. Various eponyms describing accessory or anomalous conduction pathways in addition to the normal pathway are collectively referred to as preexcitation syndromes. The latter form and associated eponyms are frequently used in literature despite controversy and disagreements over their actual anatomical existence and electrophysiological significance. This communication highlights inherent deficiencies in the knowledge that has existed since the use of such eponyms began. With the advent of curative ablation, initially surgical, and then catheter based, the knowledge gaps have been mostly filled with better delineation of the anatomic and electrophysiological properties of anomalous atrioventricular pathways. It seems reasonable, therefore, to revisit the clinical and electrophysiologic role of preexcitation syndromes in current practice.
Topics: Atrial Flutter; Atrioventricular Node; Catheter Ablation; Electrocardiography; Humans; Pre-Excitation Syndromes; Wolff-Parkinson-White Syndrome
PubMed: 26897561
DOI: 10.1016/j.cpcardiol.2015.11.002 -
Herz Feb 2023Supraventricular tachycardia is a common occurrence in routine clinical practice. As a physician, one can encounter them everywhere, whether as a general practitioner...
Supraventricular tachycardia is a common occurrence in routine clinical practice. As a physician, one can encounter them everywhere, whether as a general practitioner or as an emergency doctor in a hospital. Some tachycardias might have robbed an on-call doctor the night or the last nerve; however, supraventricular tachycardia is usually a benign condition that is easily treatable and, in many cases, even curable. This article covers the differential diagnoses of supraventricular tachycardia and its treatment options. Atrial fibrillation, also a supraventricular tachycardia, is not discussed in this article.
Topics: Humans; Tachycardia, Atrioventricular Nodal Reentry; Tachycardia, Supraventricular; Atrial Fibrillation; Wolff-Parkinson-White Syndrome; Electrocardiography; Atrial Flutter
PubMed: 36692515
DOI: 10.1007/s00059-022-05153-3 -
Europace : European Pacing,... Feb 2023Accessory pathway (AP) ablation is a standard procedure for the treatment of Wolff-Parkinson-White syndrome (WPW). Twelve-lead electrocardiogram (ECG)-based delta wave...
AIMS
Accessory pathway (AP) ablation is a standard procedure for the treatment of Wolff-Parkinson-White syndrome (WPW). Twelve-lead electrocardiogram (ECG)-based delta wave analysis is essential for predicting ablation sites. Previous algorithms have shown to be complex, time-consuming, and unprecise. We aimed to retrospectively develop and prospectively validate a new, simple ECG-based algorithm considering the patients' heart axis allowing for exact localization of APs in patients undergoing ablation for WPW.
METHODS AND RESULTS
Our multicentre study included 211 patients undergoing ablation of a single manifest AP due to WPW between 2013 and 2021. The algorithm was developed retrospectively and validated prospectively by comparing its efficacy to two established ones (Pambrun and Arruda). All patients (32 ± 19 years old, 47% female) underwent successful pathway ablation. Prediction of AP-localization was correct in 197 patients (93%) (sensitivity 92%, specificity 99%, PPV 96%, and NPV 99%). Our algorithm was particularly useful in correctly localizing antero-septal/-lateral (sensitivity and specificity 100%) and posteroseptal (sensitivity 98%, specificity 92%) AP in proximity to the tricuspid valve. The accuracy of EASY-WPW was superior compared to the Pambrun (93% vs. 84%, P = 0.003*) and the Arruda algorithm (94% vs. 75%, P < 0.001*). A subgroup analysis of children (n = 58, 12 ± 4 years old, 55% female) revealed superiority to the Arruda algorithm (P < 0.001*). The reproducibility of our algorithm was excellent (ϰ>0.8; P < 0.001*).
CONCLUSION
The novel EASY-WPW algorithm provides reliable and accurate pre-interventional ablation site determination in WPW patients. Only two steps are necessary to locate left-sided AP, and three steps to determine right-sided AP.
Topics: Humans; Adult; Child; Female; Adolescent; Young Adult; Middle Aged; Male; Wolff-Parkinson-White Syndrome; Retrospective Studies; Reproducibility of Results; Catheter Ablation; Accessory Atrioventricular Bundle; Electrocardiography; Algorithms
PubMed: 36504238
DOI: 10.1093/europace/euac216 -
Ugeskrift For Laeger Feb 2023In this case report, a previously asymptomatic 11-year-old boy presented with sudden palpitations and syncope. He eventually went into cardiac arrest and was...
In this case report, a previously asymptomatic 11-year-old boy presented with sudden palpitations and syncope. He eventually went into cardiac arrest and was successfully resuscitated. The ECG showed pre-excited atrial fibrillation degenerating into pulseless ventricular tachycardia. The patient was found to have Wolff-Parkinson-White syndrome (WPW) with an accessory pathway between right atrium and ventricle which was successfully ablated. Sudden cardiac death (SCD) is rare in WPW, however, early diagnosis is essential for eliminating the risk of SCD.
Topics: Male; Humans; Child; Wolff-Parkinson-White Syndrome; Heart Arrest; Death, Sudden, Cardiac; Atrial Fibrillation; Syncope; Electrocardiography
PubMed: 36892318
DOI: No ID Found -
Circulation. Arrhythmia and... Nov 2023The cause of hypertrophic cardiomyopathy (HCM) in the young is highly varied. Ventricular preexcitation (preexcitation) is well recognized, yet little is known about the...
BACKGROUND
The cause of hypertrophic cardiomyopathy (HCM) in the young is highly varied. Ventricular preexcitation (preexcitation) is well recognized, yet little is known about the specificity for any cause and the characteristics of the responsible accessory pathways (AP).
METHODS
Retrospective cohort study of patients <21 years of age with HCM/preexcitation from 2000 to 2022. The cause of HCM was defined as isolated HCM, storage disorder, metabolic disease, or genetic syndrome. Atrioventricular AP (true AP) were distinguished from fasciculoventricular fibers (FVF) using standard invasive electrophysiology study criteria. AP were defined as high risk if any of the following were <250 ms: shortest preexcited RR interval in atrial fibrillation, shortest paced preexcited cycle length, or anterograde AP effective refractory period.
RESULTS
We identified 345 patients with HCM and 28 (8%) had preexcitation (isolated HCM, 10/220; storage disorder, 8/17; metabolic disease, 5/19; and genetic syndrome, 5/89). Six (21%) patients had clinical atrial fibrillation (1 with shortest preexcited RR interval <250 ms). Twenty-two patients underwent electrophysiology study which identified 23 true AP and 16 FVF. Preexcitation was exclusively FVF mediated in 8 (36%) patients. Five (23%) patients had AP with high-risk conduction properties (including ≥1 patient in each etiologic group). Multiple AP were seen in 8 (36%) and AP plus FVF in 10 (45%) patients. Ablation was acutely successful in 13 of 14 patients with recurrence in 3. One procedure was complicated by complete heart block after ablation of a high-risk midseptal AP. There were significant differences in QRS amplitude and delta wave amplitude between groups. There were no surface ECG features that differentiated AP from FVF.
CONCLUSIONS
Young patients with HCM and preexcitation have a high likelihood of underlying storage disease or metabolic disease. Nonisolated HCM should be suspected in young patients with large QRS and delta wave amplitudes. Surface ECG is not adequate to discriminate preexcitation from a benign FVF from that secondary to potentially life-threatening AP.
Topics: Humans; Retrospective Studies; Atrial Fibrillation; Electrocardiography; Pre-Excitation Syndromes; Accessory Atrioventricular Bundle; Cardiomyopathy, Hypertrophic; Metabolic Diseases; Wolff-Parkinson-White Syndrome
PubMed: 37877314
DOI: 10.1161/CIRCEP.123.012191 -
The American Journal of Cardiology Jan 2018In a man with a wide-QRS complex tachycardia, a history of an inferior left ventricular scar, atrioventricular dissociation during the tachycardia, and a QRS morphology...
In a man with a wide-QRS complex tachycardia, a history of an inferior left ventricular scar, atrioventricular dissociation during the tachycardia, and a QRS morphology inconsistent with right or left bundle branch block exclude a diagnosis of supraventricular tachycardia with aberrant ventricular conduction due to bundle branch block or ventricular preexcitation and establish a diagnosis of ventricular tachycardia.
Topics: Alcoholism; Amphetamine-Related Disorders; Bundle-Branch Block; Cardiac Conduction System Disease; Cardiomyopathies; Cicatrix; Cocaine-Related Disorders; Defibrillators, Implantable; Diagnosis, Differential; Electrocardiography; Heart Block; Humans; Male; Middle Aged; Pre-Excitation Syndromes; Tachycardia, Supraventricular; Tachycardia, Ventricular
PubMed: 29132651
DOI: 10.1016/j.amjcard.2017.09.035 -
Ugeskrift For Laeger Jan 2024Paediatric patients with ventricular pre-excitation/asymptomatic WPW syndrome have a higher risk of atrial fibrillation degenerating into ventricular fibrillation and... (Review)
Review
Paediatric patients with ventricular pre-excitation/asymptomatic WPW syndrome have a higher risk of atrial fibrillation degenerating into ventricular fibrillation and sudden cardiac death (SCD). In more than half of these patients this can be the first symptom presenting. Hence, it is important to conduct a risk stratification for SCD in asymptomatic patients with pre-excitation/delta wave in the ECGs. In this review, invasive risk stratification by electrophysiologic testing and ablation is recommended when possible. Catheter ablation is reported to have a high rate of success and low risk of complications.
Topics: Child; Humans; Atrial Fibrillation; Catheter Ablation; Death, Sudden, Cardiac; Electrocardiography; Risk; Ventricular Fibrillation; Wolff-Parkinson-White Syndrome
PubMed: 38305265
DOI: 10.61409/V08230550 -
Revista Espanola de Cardiologia... Oct 2022
Topics: Humans; Pacemaker, Artificial; Pre-Excitation Syndromes
PubMed: 35523671
DOI: 10.1016/j.rec.2022.01.013 -
Developmental Period Medicine 2018Preexcitation syndromes are becoming a more often detected disease in the pediatric population. Their essential feature is the presence of additional paths / pathways in... (Review)
Review
Preexcitation syndromes are becoming a more often detected disease in the pediatric population. Their essential feature is the presence of additional paths / pathways in the heart, through which the impulse is conducted faster than physiologically. This leads to faster ventricular excitation and may lead to creating dangerous arrhythmias. The most common preexcitation syndrome is Wolff - Parkinson-White syndrome, which affects 2/ 1000 people. The presence of an accessory pathway could result in serious consequences, ranging from supraventricular tachycardia to sudden cardiac death. There are both invasive and non-invasive methods of diagnosing preexcitation syndromes. Therapeutic treatment includes pharmacotherapy and ablation, which makes it possible to permanently remove the cause of the arrhythmia.
Topics: Adolescent; Child; Child, Preschool; Female; Humans; Male; Pre-Excitation Syndromes; Wolff-Parkinson-White Syndrome
PubMed: 30056405
DOI: 10.34763/devperiodmed.20182202.179186