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Journal of Atrial Fibrillation 2014Since more than 100 years, 12-lead electrocardiography (ECG) is the standard-of-care tool, which involves measuring electrical potentials from limited sites on the body... (Review)
Review
Since more than 100 years, 12-lead electrocardiography (ECG) is the standard-of-care tool, which involves measuring electrical potentials from limited sites on the body surface to diagnose cardiac disorder, its possible mechanism and the likely site of origin. Several decades of research has led to the development of a 252-lead-ECG and CT-scan based, three dimensional, electro-imaging modality to non-invasively map abnormal cardiac rhythms including fibrillation. These maps provide guidance towards ablative therapy and thereby help advance the management of complex heart rhythm disorders. Here, we describe the clinical experience obtained using non-invasive technique in mapping the electrical disorder and guide the catheter ablation of atrial arrhythmias (premature atrial beat, atrial tachycardia, atrial fibrillation), ventricular arrhythmias (premature ventricular beats) and ventricular pre-excitation (Wolff-Parkinson-White syndrome).
PubMed: 27957124
DOI: 10.4022/jafib.1139 -
The Pan African Medical Journal 2022
Topics: Humans; Wolff-Parkinson-White Syndrome
PubMed: 36879639
DOI: 10.11604/pamj.2022.43.177.32528 -
BMC Cardiovascular Disorders May 2018Preexcitation syndrome is characterized by a dominant delta wave on the baseline electrocardiogram (ECG), resulting from the change in QRS initial vector by the...
BACKGROUND
Preexcitation syndrome is characterized by a dominant delta wave on the baseline electrocardiogram (ECG), resulting from the change in QRS initial vector by the accessory pathway (AP). This study is to explore the effect of ventricular preexcitation on the QRS initial, maximal and terminal vector in an experimental rabbit with preexcitation syndrome induced by programmed electrical stimulation.
METHODS
Rabbits (n = 10) were randomized for the experimental model of ventricular preexcitation. Sensing and stimulating electrode catheters were placed in the high right atrium and along epicardial surface of atrioventricular groove of the left ventricular anterior wall, respectively. Programmed premature stimulation S was synchronized with P wave and utilized to stimulate the ventricle. The ECG recorded the electrical activity of the heart. As compared with the QRS complex during sinus rhythm, paced QRS was assessed regarding the initial, maximal and terminal vector. PS interval and PR interval were also measured and analyzed.
RESULTS
Preexcitation was successfully simulated by ventricular pacing in the rabbits, including (1) Complete preexcitation: PS interval was less than PR interval; the difference was more than or equal to 47.00 ± 7.53 ms. (2) Incomplete preexcitation: PS interval was less than PR interval; the difference was less than 47.00 ± 7.53 ms. (3) Incomplete latent preexcitation: PS interval was more than or equal to PR interval; the difference was less than or equal to 13.00 ± 3.50 ms. (4) Complete latent preexcitation: PS interval was more than or equal to PR interval; the difference was more than 13.00 ± 3.50 ms.
CONCLUSIONS
The difference in the relative conduction velocity of the atrioventricular node versus the AP pathways determines the degree of preexcitation and different manifestation on ECG. The QRS terminal vector also reflects the ventricle preexcitation, indicating a valuable sign for the diagnosis of atypical or latent preexcitation.
Topics: Accessory Atrioventricular Bundle; Action Potentials; Animals; Atrioventricular Node; Cardiac Pacing, Artificial; Disease Models, Animal; Electrocardiography; Heart Rate; Heart Ventricles; Pre-Excitation Syndromes; Predictive Value of Tests; Rabbits; Time Factors
PubMed: 29783947
DOI: 10.1186/s12872-018-0836-y -
Journal of Cardiology Jan 2022Preexcitation-induced cardiomyopathy (PIC) is defined as a disease presenting ventricular dyssynchrony because of preexcitation through an accessory pathway (AP), being... (Review)
Review
BACKGROUND
Preexcitation-induced cardiomyopathy (PIC) is defined as a disease presenting ventricular dyssynchrony because of preexcitation through an accessory pathway (AP), being a cousin of pacing-induced cardiomyopathy. The present review aims at providing perspective of this uncharted subgroup.
METHODS
In order to determine mechanisms and clinical characteristics of PIC, 63 patients in 29 literature reports were reviewed.
RESULTS
A median age at onset was 4 (0.1-59) years; 55 patients (87%) under 18 years old including 16 infants. Twenty patients (32%) experienced supraventricular tachycardia prior and subsequent to the PIC onset. Heart failure and left ventricular (LV) dysfunction did not correlate with other clinical features. All the 65 APs identified (duplicated in 2 patients) were located on the right side of the atrioventricular junction; at the septal area (in 55%) or the anterolateral aspect (in 22%). AP conduction was successfully eliminated by medical or interventional treatments where attempted. LV function returned to normal within 6 months in 67% of patients, while recovery took longer than 3 years in 8%. Frequently seen at the basal segments of the interventricular septum were early contraction within the QRS complex, dyskinesis at mid-systole, and aneurysm/bulging or local thinning.
CONCLUSIONS
Several characteristic factors became clear as described above. Rebound stretch following early shortening of the interventricular septum is seemingly the major mechanism of PIC, and thus a right septal or right anterior/anterolateral AP needs attention as a higher risk for PIC.
Topics: Accessory Atrioventricular Bundle; Adolescent; Cardiomyopathies; Electrocardiography; Heart Ventricles; Humans; Infant; Ventricular Dysfunction, Left; Wolff-Parkinson-White Syndrome
PubMed: 34497028
DOI: 10.1016/j.jjcc.2021.08.017 -
Anaesthesiology Intensive Therapy 2019Pre-excitation is associated with life-threatening arrhythmias. Apart from the well-known Wolff-Parkinson-White syndrome, a number of rare diseases are associated with... (Review)
Review
Pre-excitation is associated with life-threatening arrhythmias. Apart from the well-known Wolff-Parkinson-White syndrome, a number of rare diseases are associated with pre-excitation due to the existence of accessory pathways. The present review aims to focus on anaesthesia and perioperative care of patients with rare genetic diseases associated with pre-excitation due to the existence of a bundle of Kent or other accessory pathways. The Danon disease, Fabry disease and Pompe disease, tuberous sclerosis, Leber hereditary optic neuropathy (LHON), and mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome are genetic multisystem disorders which may involve pre-excitation, usually combined with cardiomyopathy. The anaesthetic management of the above syndromes may become quite challenging. We conducted a PubMed and manual literature search for all types of relevant publications; we identified 58 articles suitable to be included in the present review. According to the literature, a high index of suspicion for the possibility of pre-excitation is required, and anaesthetic drugs and adjuvants should be chosen carefully, in order to prevent or at least not facilitate arrhythmias associated with accessory pathways. The perioperative management should be further tailored to the specific abnormalities of each condition. Multidisciplinary consultation and care, according to the affected organs, are mandatory for a safe outcome. The anaesthetic plan should be focused on preoperative clinical optimization and on case-specific management, tailored to the various systems involved.
Topics: Anesthesia; Anesthetics; Arrhythmias, Cardiac; Genetic Diseases, Inborn; Humans; Perioperative Care; Pre-Excitation Syndromes
PubMed: 31268275
DOI: 10.5114/ait.2019.86278 -
Cureus Jun 2020Wolff-Parkinson-White syndrome is the most common form of ventricular preexcitation and affects 1-3 per 1,000 persons worldwide. Many patients remain asymptomatic...
Wolff-Parkinson-White syndrome is the most common form of ventricular preexcitation and affects 1-3 per 1,000 persons worldwide. Many patients remain asymptomatic throughout their lives; however, approximately half of the patients with Wolff-Parkinson-White syndrome experience symptoms secondary to tachyarrhythmias, such as paroxysmal supraventricular tachycardia, atrial fibrillation, atrial flutter, and, rarely, ventricular fibrillation and sudden death. Patients with Wolff-Parkinson-White syndrome may present with a multitude of symptoms such as unexplained anxiety, palpitations, fatigue, light-headedness or dizziness, loss of consciousness, and shortness of breath. We report the case of a patient who presented with a plethora of symptoms related to generalized anxiety along with several confounding factors such as psychosocial stressors, chronic fatigue secondary to high physical and mental demands at work, a strong family history of anxiety, and a history of substance abuse. Keeping cardiac dysrhythmia within his differential diagnosis allowed for accurate diagnosis and treatment.
PubMed: 32699672
DOI: 10.7759/cureus.8672 -
European Review For Medical and... Sep 2023Our study aimed at analyzing the echocardiographic multi-indicator evaluation of the risk of Wolff-Parkinson-White syndrome (WPW) on the left ventricular function and...
Two-dimensional speckle tracking imaging to assess the hazards of left ventricular function and ventricular wall motion disorders in children with pre-excitation syndrome and the efficacy of radiofrequency ablation treatment.
OBJECTIVE
Our study aimed at analyzing the echocardiographic multi-indicator evaluation of the risk of Wolff-Parkinson-White syndrome (WPW) on the left ventricular function and ventricular wall motion disorders, as well as the effect of radiofrequency ablation treatment.
PATIENTS AND METHODS
The clinical data of 55 WPW patients treated with radiofrequency (RF) ablation at the Children's Hospital of Nanjing Medical University between January 2018 and December 2022 were retrospectively analyzed and included in the observation group, while other 50 healthy children were included in the control group during the same time. We analyzed the echocardiographic indices of the patients, assessed the effects of the disease on left ventricular myocardial function and ventricular wall motion disorders, and evaluated the effects of radiofrequency ablation treatment on the myocardium of the left ventricle. The echocardiographic parameters were analyzed to assess the effect of the disease on left ventricular myocardial function and ventricular wall dyskinesia.
RESULTS
Of the 55 patients with pre-excited syndrome, 20 had type A bypass and 35 had type B bypass. Ten patients had pre-excited dilated cardiomyopathy with significant enlargement of the left ventricular cavity, reduced left ventricular systolic function, and a significant impairment of ventricular wall motion; the other 5 patients had basal segmental septal motion incoordination. Compared to the control group, patients with left ventricular end-diastolic diameter (LVEDD) (42.9±5.0 mm vs. 39.2±3.0 mm), peak strain dispersion (PSD) (38.8±15.3 ms vs. 21.7±2.2 ms), maximum peak time difference (MPTD) (200.2±92.8 ms vs. 89.5±9.8 ms) and interventricular mechanical delay (IVMD) (36.2±13.7 ms vs. 21.2±2.1 ms) before RF ablation were increased. Left ventricular ejection fraction (LVEF) (57.1±9.1% vs. 65.9±2.6%), E/A (1.1±0.2 vs. 1.8±0.2) and global longitudinal strain (GLS) (-18.7±2.2% vs. -22.4±0.5%) decreased, with statistically significant differences (p<0.05). All 55 patients had a successful procedure, and all postoperative echocardiographic parameters were found to be improved, compared to the preoperative period. The results of the postoperative review after 3 months showed differences in E/A, PSD, MPTD, and IVMD compared to the healthy group, suggesting that left ventricular diastolic function and synchrony had not fully returned to normal.
CONCLUSIONS
Echocardiography can better evaluate myocardial motion and function in patients with Wolff-Parkinson-White syndrome and monitor the effect and progress of disease treatment, and has high clinical application value.
Topics: Humans; Child; Wolff-Parkinson-White Syndrome; Ventricular Function, Left; Stroke Volume; Heart Ventricles; Retrospective Studies; Pre-Excitation Syndromes; Echocardiography
PubMed: 37750616
DOI: 10.26355/eurrev_202309_33545 -
Turk Kardiyoloji Dernegi Arsivi : Turk... Sep 2018
Topics: Brugada Syndrome; Electrocardiography; Heart Conduction System; Humans; Wolff-Parkinson-White Syndrome
PubMed: 30204131
DOI: 10.5543/tkda.2018.75271 -
Arquivos Brasileiros de Cardiologia Jan 2022
Topics: AMP-Activated Protein Kinases; Heart Diseases; Humans; Mutation; Wolff-Parkinson-White Syndrome
PubMed: 35195217
DOI: 10.36660/abc.20210062 -
Experimental and Therapeutic Medicine Apr 2021Danon disease is an X-linked glycogen storage disease characterized by skeletal myopathy, cardiomyopathy and intellectual impairment. It is caused by a loss-of-function...
Danon disease is an X-linked glycogen storage disease characterized by skeletal myopathy, cardiomyopathy and intellectual impairment. It is caused by a loss-of-function mutation in the lysosome-associated membrane protein-2 (LAMP2) gene. In the present study, exon and boarding intron analysis of 96 cardio disease-associated genes was performed in 770 patients with hypertrophic cardiomyopathy (HCM) using second-generation sequencing. Next, the identified mutations were confirmed in family members of the patients and 300 healthy controls. Detailed clinical, electrocardiographic (ECG) and echocardiographic findings were recorded. A pathogenic mutation in LAMP2 was identified in 7 patients who phenotypically presented with HCM. A total of four patients had a fragmented QRS complex (fQRS) on surface ECG. In addition, two patients presented with ventricular preexcitation with a short PR interval. Compared with the patients with protein kinase AMP-activated non-catalytic subunit γ2 syndrome and Fabry disease, the 7 patients with Danon disease presented at an earlier age, had a smaller left atrial size, a thinner maximal left ventricular wall thickness and a lower probability of pacemaker implantation. Compared with 12 sex- and age-matched patients with sarcomere-protein mutations, the 4 patients with Danon disease had a lower left ventricular outflow tract gradient and worse diastolic function. The present study provided a comprehensive comparison of different pathologies presenting with HCM and reported on features of early-onset Danon disease, including the characteristic preexcitation and fQRS on ECG. This may provide valuable information that may be utilized for the early diagnosis and treatment of patients with Danon disease. The present study was registered as a clinical trial with ClinicalTrials.gov (Sep. 2, 2016; registry no. NCT02888132).
PubMed: 33680117
DOI: 10.3892/etm.2021.9826