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Journal of Electrocardiology 2012The purpose of the study is to report the natural changes of preexcitation syndrome (PS).
UNLABELLED
The purpose of the study is to report the natural changes of preexcitation syndrome (PS).
METHODS
Electrophysiologic study was performed for syncope (n = 8), atrioventricular reentrant tachycardia (AVRT) (n = 42), atrial fibrillation (n = 3), adverse presentation (n = 4), or for asymptomatic PS (n = 22) and was repeated 1 to 21 years later.
RESULTS
Clinically, 12 patients initially asymptomatic became symptomatic (54.5%), and 12 symptomatic patients became asymptomatic (21%). At electrophysiologic study 2, maximal rate conducted over accessory pathway (AP) was slower. Anterograde conduction disappeared in 22 patients, but 10 of them had inducible AVRT. Among 27 patients with initially rapid conduction over AP, 7 had a benign form; 20 had always a rapid conduction over AP, and 3 of them initially asymptomatic developed rapid atrial fibrillation.
CONCLUSIONS
Asymptomatic patients with a PS frequently became symptomatic (54.5%), whereas symptomatic patients rarely became asymptomatic (21%). Maximal rate conducted over AP decreased during life, but AVRT remained inducible.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Asymptomatic Diseases; Atrial Fibrillation; Child; Child, Preschool; Electrophysiologic Techniques, Cardiac; Female; Heart Conduction System; Humans; Male; Middle Aged; Pre-Excitation Syndromes; Syncope; Tachycardia, Atrioventricular Nodal Reentry; Wolff-Parkinson-White Syndrome; Young Adult
PubMed: 22498433
DOI: 10.1016/j.jelectrocard.2012.03.002 -
Pacing and Clinical Electrophysiology :... Mar 2017Ventricle preexcitation through accessory pathway changes QRS initial vector, and manifests as delta wave on electrocardiogram (ECG). However, QRS terminal vector can...
BACKGROUND
Ventricle preexcitation through accessory pathway changes QRS initial vector, and manifests as delta wave on electrocardiogram (ECG). However, QRS terminal vector can also be affected.
METHODS
A total of 158 patients who had single accessory pathway (AP) with antegrade conduction capacity were included and divided into two groups according to the ECG with or without delta wave. Note that 150 patients had delta wave (overt AP group) on ECG; classical preexcitation syndrome was diagnosed before radiofrequency ablation. Eight patients had no delta wave on ECG (unapparent AP group); preexcitation was induced by transesophageal atrial pacing. ECGs and intracardiac electrogram (IEGM) before and after ablation and during atrioventricular reentrant tachycardia were analyzed.
RESULTS
(1) In the overt AP group: QRS terminal vector amplitude and polarity changes were observed in all the 150 patients, and were related to AP location and delta wave polarity. (2) In the unapparent AP group: QRS terminal vector changes were found in two out of eight patients, and the initial activation of ventricle myocardium via AP on IEGM was almost simultaneous with the onset of QRS complex on ECG.
CONCLUSIONS
It is not only the QRS initial vector, but also the QRS terminal vector that can be changed by the antegrade accessory pathway conduction in patients with preexcitation syndrome. The change of QRS terminal vector is valuable for the diagnosis of atypical preexcitation.
Topics: Accessory Atrioventricular Bundle; Adolescent; Adult; Aged; Child; Diagnosis, Differential; Electrocardiography; Female; Humans; Male; Middle Aged; Pre-Excitation Syndromes; Reproducibility of Results; Sensitivity and Specificity; Young Adult
PubMed: 28101960
DOI: 10.1111/pace.13025 -
British Journal of Hospital Medicine... Nov 2013
Review
Topics: Athletes; Catheter Ablation; Electrocardiography; Electrocardiography, Ambulatory; Heart Diseases; Humans; Pre-Excitation Syndromes; Risk Factors; Watchful Waiting
PubMed: 24220526
DOI: 10.12968/hmed.2013.74.11.636 -
International Journal of Cardiology May 1992A sample of 4210 subjects of both sexes aged 35-54 years was examined, chosen at random from six regions of Croatia. An electrocardiogram at rest was performed in all...
A sample of 4210 subjects of both sexes aged 35-54 years was examined, chosen at random from six regions of Croatia. An electrocardiogram at rest was performed in all subjects and changes analyzed by the Minnesota code. A short P-R interval together with a widening QRS complex and a delta wave was found in 0.05%, while 42 (1.0%) of the examinees had a short P-R interval, but only 0.21% were symptomatic. Three years after the first examination 0.06% of the subjects had preexcitation with a delta wave, and in one subject it appeared after three years. 0.35% of the subjects had a short P-R interval after three years but only 0.18% were symptomatic and in 22 (0.65%) it had disappeared in three years. After 13 years these subjects did not appear for an examination, and the short P-R interval did not appear in any of other subjects during this period. There were more short P-R intervals: 3.22% in females and 1.96% in males, but 0.33% only were symptomatic. Antigens of the human leukocyte group A (HLA) system were analyzed in 46 patients: the Wolff-Parkinson-White syndrome was found in 35, while 11 had the Lown-Ganong-Levine syndrome. Antigens of the HLA-A, HLA-B and HLA-DR locuses were determined by the microlymphocytotoxicity method. The results of the frequency of HLA system antigens were compared to the results of the control group of a Croatian population consisting of 175 people. There was an increased frequency of HLA-A9 and HLA-B5 (P = 0.026 and 0.0092) in the investigated population as a whole. The participation of HLA-A3 antigen was significantly less among patients (P = 0.03), while HLA-B14 antigen was not found in patients with preexcitation. Within 10 HLA-DR locuses, HLA-DR7 antigen was rather more frequently present, although this was not statistically significant (P = 0.173).
Topics: Adult; Aged; Female; HLA Antigens; HLA-A Antigens; Humans; Lown-Ganong-Levine Syndrome; Male; Middle Aged; Pre-Excitation Syndromes; Wolff-Parkinson-White Syndrome; Yugoslavia
PubMed: 1572738
DOI: 10.1016/0167-5273(92)90175-3 -
Revista Espanola de Cardiologia... May 2012Paroxysmal supraventricular tachycardias are fast and usually regular rhythms that require some structure above the bifurcation of the His bundle to be continued. The 3... (Review)
Review
Paroxysmal supraventricular tachycardias are fast and usually regular rhythms that require some structure above the bifurcation of the His bundle to be continued. The 3 most common types are atrial tachycardias, atrioventricular nodal reentrant tachycardias, and tachycardias mediated by an accessory pathway. The last two varieties are discussed in the present manuscript. Their prognosis is benign regarding life expectancy but typically they are symptomatic and chronically recurrent, producing a certain disability. They usually occur in people without structural heart disease. Pharmacologic therapy is possible, but given the high efficacy of catheter ablation, these procedures are frequently chosen. Ventricular preexcitation is due to the presence of an accessory pathway, usually atrioventricular. The clinical course can be asymptomatic, generating a characteristic electrocardiographic pattern, produce paroxysmal supraventricular tachycardias, or facilitate other types of arrhythmias. Very rarely, they can cause sudden cardiac death. The treatment of choice for symptomatic patients is catheter ablation of the accessory pathway. The therapeutic attitude towards asymptomatic preexcitation remains controversial.
Topics: Accessory Atrioventricular Bundle; Catheter Ablation; Electrocardiography; Humans; Medical Illustration; Pre-Excitation Syndromes; Prognosis; Tachycardia, Paroxysmal; Tachycardia, Supraventricular
PubMed: 22459483
DOI: 10.1016/j.recesp.2011.11.026 -
Europace : European Pacing,... Jun 2013
Topics: Cardiac Pacing, Artificial; Electrocardiography; Electrophysiologic Techniques, Cardiac; Female; Humans; Male; Pre-Excitation Syndromes; Tachycardia, Atrioventricular Nodal Reentry
PubMed: 23355134
DOI: 10.1093/europace/eus374 -
Journal of Interventional Cardiac... Oct 2022Patients with WPW syndrome have an increased mortality rate compared to the general population. Although asymptomatic preexcitation has previously been considered...
PURPOSE
Patients with WPW syndrome have an increased mortality rate compared to the general population. Although asymptomatic preexcitation has previously been considered benign, recent studies have found that also asymptomatic patients have clinical and electrophysiological factors associated with increased risk of sudden cardiac death. This study compares the baseline electrophysiological characteristics of accessory pathways in symptomatic and asymptomatic patients with preexcitation. We hypothesized that a significant proportion of asymptomatic patients has inducible orthodromic tachycardia during programmed electrical stimulation.
METHODS
This retrospective study includes 1853 patients with preexcitation who underwent invasive electrophysiological testing in two Swedish University Hospitals between 1991 and 2018. The mean age was 36 ± 17 years with a range of 3-89 years. Thirty-nine percent was women. A total of 269 patients (15%) were children younger than 18 years. Electrophysiological data included effective refractory period of the accessory pathway (APERP, in 1069 patients), tachycardia cycle length, inducibility and type of tachycardia, and AP localization.
RESULTS
A total of 1703 (93%) patients reported symptoms suggesting tachyarrhythmias before the study and 128 (7%) were asymptomatic. The proportion of potentially dangerous pathways with short APERP (≤ 250 ms) were similar in symptomatic and asymptomatic patients (187/949, 20% vs. 25/108, 23%) (P = 0.40) as was the mean APERP (303 ± 68 ms vs. 307 ± 75) (P = 0.61). The proportion of patients who had inducible arrhythmia was larger in the symptomatic group (64% vs. 31%) (P < 0.001).
CONCLUSION
The results of this study strengthen the present guideline recommendation (IIA) to consider invasive risk assessment in patients with asymptomatic preexcitation.
Topics: Accessory Atrioventricular Bundle; Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Electrocardiography; Female; Humans; Middle Aged; Pre-Excitation Syndromes; Retrospective Studies; Tachycardia; Wolff-Parkinson-White Syndrome; Young Adult
PubMed: 35618980
DOI: 10.1007/s10840-022-01252-7 -
Acta Medica Scandinavica 1945
Topics: Heart Defects, Congenital; Humans; Pre-Excitation Syndromes; Wolff-Parkinson-White Syndrome
PubMed: 21006033
DOI: No ID Found -
Journal of Electrocardiology 2023The present case describes a dilated cardiomyopathy associated with both antidromic and orthodromic atrio-ventricular reentrant tachycardias supported by multiple right...
The present case describes a dilated cardiomyopathy associated with both antidromic and orthodromic atrio-ventricular reentrant tachycardias supported by multiple right accessory pathways. Both right accessory pathways were successfully eliminated by catheter ablation and the patient progressively recovered during the follow up. The following etiologies might be involved: 1) primitive dilated cardiomyopathy (or post-inflammatory); 2) septal dyssinchrony due to ventricular pre-excitation; 3) tachycardiomyopathy.
Topics: Humans; Wolff-Parkinson-White Syndrome; Cardiomyopathy, Dilated; Electrocardiography; Pre-Excitation Syndromes; Accessory Atrioventricular Bundle; Tachycardia, Ventricular; Catheter Ablation
PubMed: 36731165
DOI: 10.1016/j.jelectrocard.2023.01.011 -
International Heart Journal Mar 2019A 41-year-old man developed cardiac arrest. A resting 12-lead electrocardiogram showed a delta wave, suggestive of preexcitation syndrome. An electrophysiological test...
A 41-year-old man developed cardiac arrest. A resting 12-lead electrocardiogram showed a delta wave, suggestive of preexcitation syndrome. An electrophysiological test revealed the existence of inducible atrial fibrillation and a fasciculoventricular accessory pathway (FVAP). After these examinations, idiopathic ventricular arrhythmia was suspected. For evaluating concealed Brugada syndrome, pilsicainide was administered, which diminished the delta wave and no Brugada-like electrocardiogram was observed. Ventricular double extra-stimulation from the RV apex easily induced VF, which could not be defibrillated by an external defibrillator, and later stopped spontaneously. These results established the diagnosis of FVAP and idiopathic VF, and not pre-excited atrial fibrillation or Brugada syndrome.
Topics: Accessory Atrioventricular Bundle; Adult; Brugada Syndrome; Death, Sudden, Cardiac; Defibrillators; Diagnosis, Differential; Electric Countershock; Electrocardiography; Electrophysiologic Techniques, Cardiac; Humans; Male; Pre-Excitation Syndromes; Remission, Spontaneous; Treatment Failure; Ventricular Fibrillation
PubMed: 30745545
DOI: 10.1536/ihj.18-546