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Journal of Electrocardiology 2015
Topics: Adolescent; Adult; Asymptomatic Diseases; Athletes; Child; Death, Sudden, Cardiac; Diagnostic Tests, Routine; Early Diagnosis; Electrocardiography; Female; Genetic Fitness; Humans; Male; Mandatory Testing; Prognosis; Risk Assessment; Sports Medicine; Wolff-Parkinson-White Syndrome; Young Adult
PubMed: 25722079
DOI: 10.1016/j.jelectrocard.2014.12.019 -
Circulation. Heart Failure Aug 2018
Topics: Accessory Atrioventricular Bundle; Action Potentials; Cardiomyopathy, Dilated; Catheter Ablation; Echocardiography; Electrocardiography; Electrophysiologic Techniques, Cardiac; Heart Rate; Humans; Male; Recovery of Function; Severity of Illness Index; Treatment Outcome; Ventricular Dysfunction, Left; Ventricular Function, Left; Wolff-Parkinson-White Syndrome; Young Adult
PubMed: 30354564
DOI: 10.1161/CIRCHEARTFAILURE.118.004981 -
Romanian Journal of Anaesthesia and... Oct 2018Patients with pre-excitation abnormalities are at a high risk for life-threatening perioperative arrhythmias. In Wolff-Parkinson-White syndrome, the anaesthetics used... (Review)
Review
Patients with pre-excitation abnormalities are at a high risk for life-threatening perioperative arrhythmias. In Wolff-Parkinson-White syndrome, the anaesthetics used for invasive diagnostic testing/ablation, should not affect cardiac electrophysiology; propofol, sevoflurane, fentanyl, sufentanil, alfentanil are suitable. In non-ablative surgery, propofol, sevoflurane, isoflurane, fentanyl, alfentanil, sufentanil have been used safely. Among neuromuscular blockers, cis-atracurium, rocuronium and vecuronium are good choices. Ketamine, pancuronium and pethidine should be avoided because of their sympathomimetic actions. Anticholinergic/ anticholinesterase combinations for neuromuscular block reversal should preferably be omitted, while sugammadex seems more attractive. In regional anaesthesia, addition of epinephrine and high sympathetic blocks should be avoided. Hypotension should be treated with pure alpha-adrenergic agonists. Other pre-excitation abnormalities associated with different accessory pathways are the Mahaim Fiber and Lown-Ganong-Levine syndrome. Sympathetic activation should be avoided. Total intravenous anaesthesia with propofol probably represents the safest option. A careful anaesthetic plan and close cooperation with cardiologists are mandatory for successful management.
PubMed: 30393770
DOI: 10.21454/rjaic.7518.252.stk -
Pacing and Clinical Electrophysiology :... Jul 2018Many recent recommendations concern the management of preexcitation syndrome. In clinical practice, they are sometimes difficult to use. The purpose of the authors was... (Review)
Review
Many recent recommendations concern the management of preexcitation syndrome. In clinical practice, they are sometimes difficult to use. The purpose of the authors was to discuss the main problems associated with this management. Three problems are encountered: (1) the reality of the absence of symptoms or the interpretation of atypical symptoms, (2) the electrocardiographic diagnosis of preexcitation syndrome that can be missed, and (3) the exact electrophysiological protocol and its interpretation used for the evaluation of the prognosis. Because of significant progress largely related to the development of curative treatment, it seems easy to propose ablation in many patients despite the related risks of invasive studies and to minimize the invasive risk by only performing ablation for patients with at-risk pathways. However, there is a low risk of spontaneous events in truly asymptomatic patients and the indication of accessory pathway ablation should be discussed case by case.
Topics: Humans; Pre-Excitation Syndromes
PubMed: 29754436
DOI: 10.1111/pace.13367 -
Emergency Medicine Journal : EMJ Dec 2020
Topics: Aged, 80 and over; Diagnosis, Differential; Electric Countershock; Electrocardiography; Female; Humans; Wolff-Parkinson-White Syndrome
PubMed: 33229417
DOI: 10.1136/emermed-2019-209353 -
Journal of Cardiovascular... Aug 2022The notion that medically-refractory arrhythmias might one day be amenable to interventional therapy slowly began to appear in the early 1960's. At that time, there were... (Review)
Review
INTRODUCTION
The notion that medically-refractory arrhythmias might one day be amenable to interventional therapy slowly began to appear in the early 1960's. At that time, there were no "interventional electrophysiologists" or "arrhythmia surgeons" and there was little appreciation of the relationship between anatomy and electrophysiology outside the heart's specialized conduction system.
METHODS
In this review, we describe the evolution of collaboration between electrophysiologists and surgeons.
RESULTS
Although accessory atrio-ventricular (AV) connections were first identified in 1893 and the Wolff-Parkinson-White (WPW) syndrome was described 37 years later (1930), it was another 37 years (1967) before those anatomic AV connections were proven to be responsible for the clinical syndrome. The success of the subsequent surgical procedures for the WPW syndrome, AV node reentry tachycardia, automatic atrial tachycardias, ischemic and non-ischemic ventricular tachycardias and atrial fibrillation over the next two decades depended on a close, sometimes daily, collaboration between electrophysiologists and surgeons. In the past two decades, that tight collaboration was largely abandoned until the recent introduction of "hybrid procedures" for the treatment of atrial fibrillation.
CONCLUSIONS
A retrospective assessment of the 50 years of interventional therapy for arrhythmias clearly demonstrates the clinical benefits of a close collaboration between electrophysiologists and arrhythmia surgeons, regardless of which one is actually performing the intervention.
Topics: Atrial Fibrillation; Humans; Retrospective Studies; Surgeons; Tachycardia, Atrioventricular Nodal Reentry; Wolff-Parkinson-White Syndrome
PubMed: 35695795
DOI: 10.1111/jce.15598 -
Circulation. Arrhythmia and... Apr 2023To investigate the clinical features of preexcitation-induced dilated cardiomyopathy in infants and evaluate safety and efficacy of radiofrequency ablation (RFCA) in...
BACKGROUND
To investigate the clinical features of preexcitation-induced dilated cardiomyopathy in infants and evaluate safety and efficacy of radiofrequency ablation (RFCA) in these patients.
METHODS
This study included 10 infants (4 males and 6 females) with mean age of 6.78±3.14 months, mean weight of 8.11±1.71 kg, and mean left ventricular ejection fraction (LVEF) was 32.6±10.34%. Tachycardiomyopathy has been excluded and all patients were refractory to the drugs. All of these 10 patients underwent RFCA.
RESULTS
All the accessory pathways in these patients were located on right free wall and the acute success rate was 100%. No complication associated with the procedure occurred. In one case preexcitation recurred and was ablated successfully during the second attempt. There were 3 patients with mild cardiac dysfunction (LVEF, 40≤LVEF<50%), 3 with moderate (30≤LVEF<40%), and 4 with severe cardiac dysfunction (LVEF<30%, the ages were 3, 6, 7, and 10 months, respectively). The time for LVEF normalization was 1 week, 1 to 3 months, and ≥3 months, respectively. In 3 of the 4 severe cardiac dysfunction patients, the LVEF normalized at 3, 6, and 12 months after ablation, the LVEF of the remaining case did not recover at 3 months and is still being followed.
CONCLUSIONS
Ventricular preexcitation could lead to severe cardiac dysfunction during infancy. RFCA may be a safe and effective treatment option in right free wall accessory pathways, even in infants with cardiac dysfunction. Cases of more severe cardiac dysfunction might require a longer time for LVEF recovery after RFCA.
Topics: Male; Female; Humans; Infant; Stroke Volume; Cardiomyopathy, Dilated; Ventricular Function, Left; Catheter Ablation; Pre-Excitation Syndromes; Treatment Outcome; Heart Diseases
PubMed: 36891895
DOI: 10.1161/CIRCEP.122.011569 -
Clinical Cardiology Aug 2020Accessory pathways are present in 1 in 300 young individuals. They are often asymptomatic and potentially lethal arrhythmias may be the first presentation. During... (Review)
Review
Accessory pathways are present in 1 in 300 young individuals. They are often asymptomatic and potentially lethal arrhythmias may be the first presentation. During long-term follow-up, up to 20% of asymptomatic individuals with pre-excitation go on to develop an arrhythmia and the absence of traditional clinical and electrophysiological high-risk markers does not guarantee the "safe" nature of an accessory pathway. The widespread availability of permanent cure for the condition at low risk by catheter ablation, creates an incentive to screen for accessory pathways with a 12-lead ECG, particularly in individuals who are perceived to be at increased risk, such as athletes and high-risk professions. We review the existing literature on the assessment and management of accessory pathways (Wolff-Parkinson-White [WPW] syndrome) and discuss its implications for the young athletic population.
Topics: Athletes; Catheter Ablation; Electrocardiography; Heart Conduction System; Heart Rate; Humans; Wolff-Parkinson-White Syndrome
PubMed: 32592213
DOI: 10.1002/clc.23399 -
Journal of Veterinary Cardiology : the... Jun 2023Atrioventricular accessory pathways are abnormal electrical connections between the atria and ventricles that predispose to ventricular pre-excitation (VPE) and...
OBJECTIVES
Atrioventricular accessory pathways are abnormal electrical connections between the atria and ventricles that predispose to ventricular pre-excitation (VPE) and tachycardias.
ANIMALS
Seventeen cats with VPE and 15 healthy matched-control cats.
MATERIAL AND METHODS
Multicenter case-control retrospective study. Clinical records were searched for cats with VPE, defined as preserved atrioventricular synchrony, reduced PQ interval, and increased QRS complex duration with a delta wave. Clinical, electrocardiography, echocardiographic, and outcome data were collated.
RESULTS
Most cats with VPE were male (16/17 cats), non-pedigree cats (11/17 cats). Median age and mean body weight were 5.4 years (0.3-11.9 years) and 4.6 ± 0.8 kg, respectively. Clinical signs at presentation included lethargy (10/17 cats), tachypnea (6/17 cats), and/or syncope (3/17 cats). In two cats, VPE was an incidental finding. Congestive heart failure was uncommon (3/17 cats). Nine (9/17) cats had tachyarrhythmias: 7/9 cats had narrow QRS complex tachycardia and 2/9 cats had wide QRS complex tachycardia. Four cats had ventricular arrhythmias. Cats with VPE had larger left (P < 0.001) and right (P < 0.001) atria and thicker interventricular septum (P = 0.019) and left ventricular free wall (P = 0.028) than controls. Three cats had hypertrophic cardiomyopathy. Treatment included different combinations of sotalol (5/17 cats), diltiazem (5/17 cats), atenolol (4/17 cats), furosemide (4/17 cats), and platelet inhibitors (4/17 cats). Five cats died, all from cardiac death (median survival time 1882 days [2-1882 days]).
CONCLUSIONS
Cats with VPE had a relatively long survival, albeit showing larger atria and thicker left ventricular walls than healthy cats.
Topics: Male; Cats; Animals; Female; Wolff-Parkinson-White Syndrome; Retrospective Studies; Pre-Excitation Syndromes; Tachycardia; Electrocardiography; Cat Diseases
PubMed: 37267820
DOI: 10.1016/j.jvc.2023.04.005 -
Trends in Cardiovascular Medicine May 2017For years, conventional wisdom has held that patients with asymptomatic ventricular pre-excitation (asymptomatic WPW or WPW pattern) were at low risk for adverse... (Review)
Review
For years, conventional wisdom has held that patients with asymptomatic ventricular pre-excitation (asymptomatic WPW or WPW pattern) were at low risk for adverse outcomes. This assumption has been challenged more recently in a number of observational/natural history studies as well as in prospective trials in which patients were more aggressively studied via invasive electrophysiology study (EPS) and more aggressively treated, in some cases, with pre-emptive catheter ablation, despite the lack of symptoms. In sum, the data do not definitively support one approach (early, up-stream EPS and/or ablation) vs. the other (watchful waiting with close monitoring). The most recent pediatric and adult guidelines reflect this ambiguity with a broad spectrum of approaches endorsed.
Topics: Action Potentials; Adolescent; Adult; Algorithms; Asymptomatic Diseases; Catheter Ablation; Child; Critical Pathways; Death, Sudden, Cardiac; Electrocardiography; Electrophysiologic Techniques, Cardiac; Heart Conduction System; Heart Rate; Humans; Middle Aged; Practice Guidelines as Topic; Predictive Value of Tests; Prognosis; Risk Assessment; Risk Factors; Time Factors; Watchful Waiting; Wolff-Parkinson-White Syndrome; Young Adult
PubMed: 28108086
DOI: 10.1016/j.tcm.2016.12.001