-
Journal of Cardiovascular... Nov 2023Herein, we present a rare case of the successful ablation of an accessory pathway (AP) involving the Marshall Bundle (MB) and coronary sinus musculature (CSM) in a...
INTRODUCTION
Herein, we present a rare case of the successful ablation of an accessory pathway (AP) involving the Marshall Bundle (MB) and coronary sinus musculature (CSM) in a 40-year-old man with Wolff-Parkinson-White syndrome.
METHODS AND RESULTS
An orthodromic reciprocating tachycardia (ORT) was inducible with the earliest atrial activation site located at the posterolateral mitral annulus. The local conduction and the cycle length of ORT was prolonged by peri-mitral ablation; however, it failed to block the AP. The atrial insertion of the AP was identified by remapping during ORT at the left atrial ridge, which was away from the mitral annulus, where ablation was successful. Together with the electrophysiological findings in CSM potentials, we conclude that the epicardial MB-CSM connection functioned as the AP in this patient.
CONCLUSION
The novel variant form of AP comprised of MB and CSM should be noted. The atrial insertion of the MB may be the target of catheter ablation.
Topics: Male; Humans; Adult; Coronary Sinus; Accessory Atrioventricular Bundle; Tachycardia, Reciprocating; Bundle of His; Wolff-Parkinson-White Syndrome; Catheter Ablation; Electrocardiography
PubMed: 37727933
DOI: 10.1111/jce.16075 -
Atencion Primaria Mar 2024
Topics: Humans; Male; Bicycling; Wolff-Parkinson-White Syndrome
PubMed: 38219391
DOI: 10.1016/j.aprim.2023.102844 -
Pediatric Cardiology Feb 2024Limited data are available concerning supraventricular tachycardia (SVT) recurrence. Hence, this study aimed to determine the incidence, outcome, and factors associated... (Observational Study)
Observational Study
Limited data are available concerning supraventricular tachycardia (SVT) recurrence. Hence, this study aimed to determine the incidence, outcome, and factors associated with SVT recurrence. This retrospective, observational, population-based study was conducted among children with SVT from 2006 to 2020. The primary outcome measure was SVT recurrence. Kaplan Meier analysis was used to estimate SVT-free at 1, 5, and 10 years after diagnosis. Cox regression analysis was used to identify independent factors associated with recurrence. There were 156 patients with SVT with a median age at diagnosis of 1.9 years (Interquartile range [IQR] 11 days to 8.7 years) and follow-up for a median of 3.5 years (IQR 1.7 to 6.1 years). 35 patients (22%) had recurrent SVT at a median age of 7.8 years (IQR 4.4 to 12 years). Infants with Wolff-Parkinson-White Syndrome (WPW) had the highest recurrence (11/16, 68%), with 33% SVT-free at 5 years follow-up. The lowest recurrence rate was observed in neonatal diagnosis (2/54, 3.7%) with 98% SVT-free at 5 years follow-up. The independent factors associated with the recurrence of SVT were the diagnosis of WPW with an adjusted hazard ratio (aHR) of 5.2 (95% CI 2.4-11.2), age of more than 1 year at diagnosis (aHR 3.7 95% CI 1.4-9.7), and combine with or need second-line therapy (aHR 4.0 95% CI 1.5-10.7). One in five children with SVT experienced a recurrence, which is more likely for those with WPW, multiple maintenance therapy, and older age at first presentation. Whereas neonates with non-WPW may benefit from shorter maintenance therapy.
Topics: Infant; Infant, Newborn; Child; Humans; Child, Preschool; Retrospective Studies; Incidence; Tachycardia, Supraventricular; Wolff-Parkinson-White Syndrome
PubMed: 38165467
DOI: 10.1007/s00246-023-03374-9 -
European Heart Journal. Cardiovascular... May 2024
Topics: Humans; Wolff-Parkinson-White Syndrome; Female; Adult; Mutation; AMP-Activated Protein Kinases; Electrocardiography; Echocardiography; Cardiomegaly
PubMed: 38270345
DOI: 10.1093/ehjci/jeae016 -
Internal Medicine (Tokyo, Japan) Feb 2024A 20-year-old man was resuscitated after ventricular fibrillation (VF). Electrocardiography revealed Wolff-Parkinson-White (WPW) syndrome. Intracoronary acetylcholine...
Utility of Intracoronary Acetylcholine Provocation Testing in Inducing Atrial Fibrillation with Preexcitation Followed by Ventricular Fibrillation in a Patient with Wolff-Parkinson-White Syndrome: A Case Report.
A 20-year-old man was resuscitated after ventricular fibrillation (VF). Electrocardiography revealed Wolff-Parkinson-White (WPW) syndrome. Intracoronary acetylcholine provocation testing was performed to induce VF secondary to the coronary vasospasm. The administration of acetylcholine to the coronary artery induced atrial fibrillation (AF) with pre-excitation, followed by VF without coronary vasospasm. Electrophysiological studies revealed an accessory pathway managed by catheter ablation. Subsequent intracoronary acetylcholine provocation testing (ACH test) induced the occurrence of AF without preexcitation. To our knowledge, this case report is the first to demonstrate the utility of the ACH test in confirming WPW syndrome as a cause of VF.
PubMed: 38369356
DOI: 10.2169/internalmedicine.3000-23 -
Journal of Cardiovascular... Jun 2024Precise electrocardiographic localization of accessory pathways (AP) can be challenging. Seminal AP localization studies were limited by complexity of algorithms and...
INTRODUCTION
Precise electrocardiographic localization of accessory pathways (AP) can be challenging. Seminal AP localization studies were limited by complexity of algorithms and sample size. We aimed to create a nonalgorithmic method for AP localization based on color-coded maps of AP distribution generated by a web-based application.
METHODS
APs were categorized into 19 regions/types based on invasive electrophysiologic mapping. Preexcited QRS complexes were categorized into 6 types based on polarity and notch/slur. For each QRS type in each lead the distribution of APs was visualized on a gradient map. The principle of common set was used to combine the single lead maps to create the distribution map for AP with any combination of QRS types in several leads. For the validation phase, a separate cohort of APs was obtained.
RESULTS
A total of 800 patients with overt APs were studied. The application used the exploratory data set of 553 consecutive APs and the corresponding QRS complexes to generate AP localization maps for any possible combination of QRS types in 12 leads. Optimized approach (on average 3 steps) for evaluation of preexcited electrcardiogram was developed. The area of maximum probability of AP localization was pinpointed by providing the QRS type for the subsequent leads. The exploratory data set was validated with the separate cohort of APs (n = 256); p = .23 for difference in AP distribution.
CONCLUSIONS
In the largest data set of APs to-date, a novel probabilistic and semi-automatic approach to electrocardiographic localization of APs was highly predictive for anatomic localization.
Topics: Humans; Action Potentials; Predictive Value of Tests; Accessory Atrioventricular Bundle; Electrophysiologic Techniques, Cardiac; Heart Rate; Reproducibility of Results; Male; Mobile Applications; Female; Signal Processing, Computer-Assisted; Electrocardiography; Adult; Algorithms; Time Factors; Middle Aged; Young Adult
PubMed: 38514968
DOI: 10.1111/jce.16252 -
CJC Open Mar 2024
PubMed: 38559330
DOI: 10.1016/j.cjco.2023.12.009 -
Annals of Noninvasive Electrocardiology... Jul 2024A 23-year-old male with a history of ventricular pre-excitation and atrial flutter presented for evaluation after recurrent syncope. The possible mechanism of syncope...
A 23-year-old male with a history of ventricular pre-excitation and atrial flutter presented for evaluation after recurrent syncope. The possible mechanism of syncope erroneously attributed to pre-excited atrial flutter with fast heart rates in the first hospitalization. The patient was found to have advanced heart block and PRKAG2 genetic mutation in the second hospitalization. The genetic findings and clinical features are consistent with PRKAG2 syndrome (PS). PS is a rare, autosomal dominant inherited disease, characterized by ventricular pre-excitation, supraventricular tachycardia, and cardiac hypertrophy. It is frequently followed by atrial-fibrillation-induced ventricular fibrillation and advanced heart blocks. An accurate differential diagnosis of syncope is important because of the different arrhythmic features and clinical course of PS.
Topics: Humans; Male; Young Adult; Electrocardiography; Accessory Atrioventricular Bundle; Diagnosis, Differential; Syncope; AMP-Activated Protein Kinases; Syndrome
PubMed: 38937983
DOI: 10.1111/anec.13134 -
[Right bundle branch block or ventricular preexcitation? Sometimes the solution lies in the middle].Giornale Italiano Di Cardiologia (2006) Jul 2024
Topics: Humans; Bundle-Branch Block; Electrocardiography; Pre-Excitation Syndromes; Male; Diagnosis, Differential; Middle Aged
PubMed: 38916461
DOI: 10.1714/4282.42633