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Pacing and Clinical Electrophysiology :... Jan 2016Intermittent Wolff-Parkinson-White (WPW) syndrome is considered to have a lower risk of sudden death. Fewer data exist regarding electrophysiologic (EP) characteristics...
BACKGROUND
Intermittent Wolff-Parkinson-White (WPW) syndrome is considered to have a lower risk of sudden death. Fewer data exist regarding electrophysiologic (EP) characteristics and the natural history of intermittent WPW in children.
METHODS
All patients with WPW age 1-18 years at a single institution (1996-2013) were reviewed. Patients with intermittent preexcitation were compared to those with loss of preexcitation on Holter/exercise testing and those with persistent preexcitation. High-risk accessory pathway (AP) was defined as AP effective refractory period (APERP), block cycle length, or shortest preexcited RR interval during atrial fibrillation ≤250 ms.
RESULTS
A total of 295 patients were included: 226 (76.6%) persistent, 39 (13.2%) intermittent, and 30 (10.2%) loss of preexcitation Holter/exercise. There were no differences in symptoms between groups. Median interquartile range APERP was significantly longer in intermittent WPW (380 [320, 488] ms vs 320 [300, 350] ms persistent, 310 [290, 330] ms loss of preexcitation Holter/exercise; P = 0.0008). At baseline, there was no difference between groups in frequency of high-risk pathways. However, when isoproterenol values were included, high-risk pathways were more frequent among patients with loss of preexcitation on Holter/exercise (54% vs 16% persistent, 11% intermittent; P = 0.005). There was one death in a patient with loss of preexcitation on exercise testing, no EP study, and prior drug use. A second patient with persistent WPW and APERP 270 ms required resuscitation following a methadone overdose.
CONCLUSION
Intermittent preexcitation in children does not connote a lower risk AP by EP criteria or reduced symptoms. The low number of pediatric WPW patients who develop preexcited atrial fibrillation or sudden death warrants larger studies to investigate these outcomes.
Topics: Accessory Atrioventricular Bundle; Adolescent; Age Distribution; Causality; Child; Child, Preschool; Chronic Disease; Comorbidity; Electrocardiography; Female; Humans; Infant; Male; Pre-Excitation Syndromes; Prevalence; Prognosis; Recurrence; Reproducibility of Results; Sensitivity and Specificity; Sex Distribution; Survival Rate; Wolff-Parkinson-White Syndrome
PubMed: 26256551
DOI: 10.1111/pace.12732 -
Heart (British Cardiac Society) Apr 1998Wolff-Parkinson-White syndrome is thought to be a congenital disease, however, its exact prevalence is not known. This may be because of the intermittent activity of...
BACKGROUND
Wolff-Parkinson-White syndrome is thought to be a congenital disease, however, its exact prevalence is not known. This may be because of the intermittent activity of accessory pathways in some cases and fluctuations in autonomic tone.
AIMS
To investigate the prevalence of ventricular preexcitation by electrocardiography and reported symptoms in each school age child in Yamanashi prefecture.
METHODS
From 1994 to 1996, answers to a questionnaire, results of physical examination, and electrocardiography were obtained from all schoolchildren in Yamanashi prefecture (n = 92,161; total population 880,000) on admission to elementary school (age 6 to 7 years, n = 28,395), junior high school (age 12 to 13 years, n = 31,206), and high school (age 14 to 15 years, n = 32,837).
RESULTS
Elementary and junior high school students had a significantly lower prevalence of preexcitation than high school students (0.073% and 0.070% v 0.174%, p < 0.001). The prevalence of left free wall pathway was highest in high school students (n = 27) compared with elementary (n = 6) and junior high school students (n = 5) (p < 0.005). The only symptom noted in the answers to the questionnaire was palpitations. The symptomatic cases were more frequent in high school (n = 13) than in elementary (n = 1) and junior high school (n = 2) children, but not significantly. No student with preexcitation had associated heart disease or family history of Wolff-Parkinson-White syndrome or sudden death.
CONCLUSIONS
The prevalence of preexcitation in younger schoolchildren was less frequent than previously reported. The prevalence of preexcitation and left free wall pathways increased with age. The symptoms were few and there was no significant morbidity.
Topics: Adolescent; Age Factors; Child; Electrocardiography; Humans; Japan; Pre-Excitation Syndromes; Prevalence
PubMed: 9616346
DOI: 10.1136/hrt.79.4.374 -
Zhonghua Fu Chan Ke Za Zhi Oct 2020To investigate the characteristics of pregnancy with pre-excitation syndrome and its influence on pregnancy outcomes. A retrospective analysis was made on the clinical...
To investigate the characteristics of pregnancy with pre-excitation syndrome and its influence on pregnancy outcomes. A retrospective analysis was made on the clinical data of 62 cases of pregnancy complicated with pre-excitation syndrome in Beijing Anzhen Hospital from Jan. 2008 to Dec. 2008. According to whether there was a supraventricular tachycardia (SVT) in pregnancy, they were divided into two groups. There were 16 pregnant women in the SVT seizure group during pregnancy, and 46 pregnant women in no SVT seizure group, with a multi-disciplinary comprehensive diagnosis and treatment model. SPSS software was used to analyze the data and compare the gestational age, age and weight of the newborn, and then compare the pregnancy outcomes. (1) The total number of deliveries in Beijing Anzhen Hospital during the study period was 21 786, and the patients with pregnancy combined with pre-excitation syndrome account for 0.28% (62/21 786). (2) Totally 44 patients (71%, 44/62) were diagnosed with pre-excitation syndrome before pregnancy, and 18 patients (29%, 18/62) were diagnosed for the first-time during pregnancy. Among patients diagnosed with pre-excitation syndrome before pregnancy, 16 patients (36%, 16/44) had seizures before pregnancy, 28 patients (64%, 28/44) had asymptomatic before pregnancy, and 4 of asymptomatic patients had SVT during pregnancy. (3) Of the 16 pregnant women in the SVT seizure group during pregnancy, 2 patients (2/16) had SVT episodes in the first trimester, 5 patients (5/16) had SVT episodes in the second trimester, 9 patients (9/16) had SVT episodes in the third trimester. In the SVT seizure group, 8 patients (8/16) had SVT episodes before pregnancy, and 8 patients (8/16) had no SVT episodes before pregnancy. There were 46 patients in the SVT seizure-free group during pregnancy, including 9 patients with SVT attacks before pregnancy and 37 patients without SVT before pregnancy. (4) Compared with the pregnant women in the SVT seizure group, the age, weight gained during pregnancy, delivery gestation week, newborn weight, and the time of the first and second labors were not statistically different between the two groups of pregnant women (all >0.05). However, the total duration of labor in the SVT seizure group during pregnancy was shorter and pre-pregnancy weight was lower (all <0.05). The rate of cesarean section in pregnant women with SVT attack was 12/16, and the rate of cesarean section in pregnant women without SVT was 50% (23/46; =0.051). No pregnant woman had an arrhythmia during delivery. SVT episode in patients during pregnancy most occurs in the third trimester. Patients who are asymptomatic before pregnancy may also have SVT during pregnancy. Pre-excitation syndrome patients with SVT attacks during pregnancy increase adverse pregnancy outcomes. Multidisciplinary comprehensive management could effectively control pregnant women with pre-excitation syndrome, effectively reduce the occurrence of serious arrhythmia risk events during pregnancy, so that most patients could get good pregnancy outcomes.
Topics: Cesarean Section; China; Female; Gestational Age; Humans; Infant, Newborn; Pre-Excitation Syndromes; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Retrospective Studies
PubMed: 33120480
DOI: 10.3760/cma.j.cn112141-20200425-00354 -
Pacing and Clinical Electrophysiology :... Dec 2022Wolff-Parkinson-White (WPW) concomitant with atrial tachyarrhythmia (ATA) has not been systemically characterized.
BACKGROUND
Wolff-Parkinson-White (WPW) concomitant with atrial tachyarrhythmia (ATA) has not been systemically characterized.
METHODS
Detailed electroanatomical mapping of the right atrium (RA) and/or left atrium (LA) was performed using three-dimensional mapping and the accessory pathway (AP) was mapped.
RESULTS
WPW syndrome with ATA was diagnosed in 11 patients (median age 60 years). The characteristic of unidirectional anterograde conduction over the AP was displayed in nine patients, six of whom were intermittent. Sustained atrial tachycardia, that is, counterclockwise atrial flutter (AFL) with a median tachycardia cycle length (TCL) of 225 (220-275) ms, was mapped in eight patients; furthermore, "figure 8" right atrial reentry was mapped with TCL 250 ms in one patient with a surgical history of ventricular septal defect repair. The remaining two patients underwent mitral annulus-dependent AT after paroxysmal atrial fibrillation (PAF) ablation and LA micro-reentry AT, respectively. In four patients, the location of the APs was left posterior. Left-lateral APs were identified in four patients. The locations of the APs in the remaining three patients were the right posterior and middle septum. All ATAs and APs were successfully ablated. After a median follow-up of 37 (15-72) months, no anterograde conduction over the AP was recorded, new onset of PAF was recorded in three patients, and all of them underwent circumferential pulmonary vein isolation.
CONCLUSIONS
WPW with concomitant ATA frequently had continuous anterograde conduction over the AP with a rapid ventricular rate. Most WPWs displayed the characteristic of unidirectional anterograde conduction.
Topics: Humans; Middle Aged; Pre-Excitation Syndromes; Heart Atria
PubMed: 36209460
DOI: 10.1111/pace.14598 -
Europace : European Pacing,... Feb 2019Atypical bypass tracts or variants of ventricular pre-excitation are rare anatomic structures often with rate-dependent slowing in conduction, called decremental... (Review)
Review
Atypical bypass tracts or variants of ventricular pre-excitation are rare anatomic structures often with rate-dependent slowing in conduction, called decremental conduction. During sinus rhythm, electrocardiographic recognition of those structures may be difficult because unlike in the Wolff-Parkinson-White syndrome where usually overt ventricular pre-excitation is present, the electrocardiogram (ECG) often shows a subtle pre-excitation pattern because of less contribution to ventricular activation over the slow and decrementally conducting bypass. Following the structure described by Ivan Mahaim and Benatt corresponding to a fasciculoventricular pathway, several other new variants of ventricular pre-excitation were reported. In this review, we aim to discuss the electrocardiographic pattern of the different subtypes of variants of ventricular pre-excitation, including the atriofascicular pathway, long and short decrementally conducting atrioventricular pathways, fasciculoventricular pathway, the atrio-Hisian bypass tract, and nodoventricular and nodofascicular fibres. Emphasis will be on the ECG findings during sinus rhythm.
Topics: Accessory Atrioventricular Bundle; Action Potentials; Adenosine; Animals; Electrocardiography; Heart Conduction System; Heart Rate; Humans; Pre-Excitation Syndromes; Pre-Excitation, Mahaim-Type; Predictive Value of Tests
PubMed: 29788238
DOI: 10.1093/europace/euy079 -
Cardiovascular Research Apr 1996
Review
Topics: Atrioventricular Node; Electrocardiography; Humans; Pre-Excitation Syndromes
PubMed: 8689639
DOI: No ID Found -
Pacing and Clinical Electrophysiology :... Aug 2011Sudden cardiac death can be the first clinical presentation of asymptomatic ventricular preexcitation. Recent data about prevalence of preexcitation in the...
BACKGROUND
Sudden cardiac death can be the first clinical presentation of asymptomatic ventricular preexcitation. Recent data about prevalence of preexcitation in the electrocardiograms (ECG) of the general population are scarce.
OBJECTIVE
The aim of the present study was to analyze the prevalence of preexcitation in a contemporary population of young conscripts.
METHODS
We reanalyzed all consecutive ECGs of Swiss citizens who underwent conscription for the army between March 1, 2004, and July 31,2006. All ECGs with the diagnosis preexcitation were included in the present study.
RESULTS
We analyzed ECGs of 41,699 male conscripts. Mean age was 19.2 ± 1.1 years. Preexcitation was found in 53 individuals. The length of the delta wave was 46 ± 10 ms. The most frequent localization of the accessory pathway was the left free wall.
CONCLUSION
The prevalence of preexcitation in young, predominantly male conscripts is 0.13%. This is comparable with previous findings in children.
Topics: Death, Sudden, Cardiac; Electrocardiography; Humans; Male; Pre-Excitation Syndromes; Prevalence; Retrospective Studies; Switzerland; Young Adult
PubMed: 21453334
DOI: 10.1111/j.1540-8159.2011.03085.x -
Circulation Journal : Official Journal... Jan 2022Danon disease is typically associated with cardiomyopathy and ventricular pre-excitation. The study aimed to characterize the clinical profile of Danon disease, analyze...
BACKGROUND
Danon disease is typically associated with cardiomyopathy and ventricular pre-excitation. The study aimed to characterize the clinical profile of Danon disease, analyze electrocardiographic (ECG) and electrophysiologic features, and investigate their association with Wolff-Parkinson-White (WPW) syndrome and fasciculoventricular pathways (FVPs).Methods and Results:Clinical course, family history, ECG and electrophysiological data were collected from 16 patients with Danon disease. Over 0.4-8 years of follow up, 1 female patient died suddenly, and 5 male patients died of progressive heart failure by age 13-20 years. Family history analysis revealed that 3 mothers experienced hospitalization or death for heart failure at age 28-41 years. There was 100% penetrance for ECG abnormalities in 13 patients with original ECGs. Short PR intervals and delta waves were present in 9 and 8 patients, respectively. There were significant age-associated increases in the QRS complex width (r=0.556, P=0.048) and the number of leads with notched QRS (r=0.575, P=0.04). Four patients who underwent electrophysiological studies all had FVPs, and 2 of them still had left-side atrioventricular pathways.
CONCLUSIONS
Danon disease causes a malignant clinical course characterized by early death caused by heart failure in both genders and progressive ECG changes as patients age. The pre-excited ECG pattern is related to FVPs and WPW, which is suggestive of extensive cardiac involvement.
Topics: Accessory Atrioventricular Bundle; Adolescent; Adult; Arrhythmias, Cardiac; Electrocardiography; Female; Glycogen Storage Disease Type IIb; Heart Failure; Humans; Male; Pre-Excitation Syndromes; Wolff-Parkinson-White Syndrome; Young Adult
PubMed: 34937809
DOI: 10.1253/circj.CJ-21-0572 -
Journal of Electrocardiology 2020Fasciculoventricular pathway (FVP) is a rare form of preexcitation syndrome. A FVP connects the fascicle and the ventricle. It is indistinguishable to the common...
Fasciculoventricular pathway (FVP) is a rare form of preexcitation syndrome. A FVP connects the fascicle and the ventricle. It is indistinguishable to the common preexcitation pathways on the 12‑lead electrocardiography. We herein present a case of FVP, who was with the same His-ventricular interval and QRS morphology during sinus rhythm, junctional beats and rapid atrial pacing rhythm. Using a mapping catheter at the right ventricular anterior (RV) wall, we can clearly demonstrate the activation of RV with and without FVP conduction. With FVP conduction, the RV was activated from basal wall to apex. Without FVP conduction, the activation direction was reversed.
Topics: Accessory Atrioventricular Bundle; Cardiac Pacing, Artificial; Electrocardiography; Heart Rate; Heart Ventricles; Humans; Pre-Excitation Syndromes
PubMed: 32866911
DOI: 10.1016/j.jelectrocard.2020.08.015 -
International Journal of Cardiology Jun 2014The aim of study was to report different and unusual patterns of preexcitation syndrome (PS) noted in patients referred for studied for poorly-tolerated arrhythmias and...
UNLABELLED
The aim of study was to report different and unusual patterns of preexcitation syndrome (PS) noted in patients referred for studied for poorly-tolerated arrhythmias and their frequency. Electrophysiologic study (EPS) is an easy means to identify a patient with PS at risk of serious events. However the main basis for this diagnosis is the ECG which associates short PR interval and widening of QRS complex with a delta wave.
METHODS
ECGs of 861 patients in whom PS related to an atrioventricular accessory pathway (AP) was identified at electrophysiological study (EPS), were studied.
RESULTS
The most frequent unusual presentation (9.6%) was the PS presenting with a normal or near normal ECG, noted preferentially for left lateral AP and rarely for posteroseptal or right lateral location. More exceptional (0.1%) was the presence of a long PR interval, which did not exclude a rapid conduction over AP. The association of a complete AV block with symptomatic tachycardias was exceptional (0.3%) and was shown related to a rapid conduction over AP after isoproterenol. Most of the presented patients were at high-risk at EPS.
CONCLUSION
The diagnosis of PS is not always evident and symptoms should draw attention to minor abnormalities and lead to enlarge indications of EPS, only means to confirm or not PS.
Topics: Adult; Arrhythmias, Cardiac; Electrocardiography; Humans; Male; Middle Aged; Pre-Excitation Syndromes; Retrospective Studies
PubMed: 24794061
DOI: 10.1016/j.ijcard.2014.04.114