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The American Journal of Emergency... Sep 2009Preexcitation syndromes are a common cause of paroxysmal tachycardias presenting to the ED. Emergency physicians should be familiar with the common electrocardiographic...
Preexcitation syndromes are a common cause of paroxysmal tachycardias presenting to the ED. Emergency physicians should be familiar with the common electrocardiographic manifestations of preexcitation, particularly the Wolff-Parkinson-White abnormality, as these conditions require specific therapeutic management. This article reviews the pathophysiology of preexcitation, along with the electrocardiographic findings of Wolff-Parkinson-White and its associated tachyarrhythmias.
Topics: Comorbidity; Electrocardiography; Emergency Service, Hospital; Heart Conduction System; Humans; Pre-Excitation Syndromes; Tachycardia, Atrioventricular Nodal Reentry; Wolff-Parkinson-White Syndrome
PubMed: 19683122
DOI: 10.1016/j.ajem.2008.06.013 -
Journal of Electrocardiology 2021A 45-year-old lady was evaluated for recurrent episodes of palpitation. Her 12‑lead electrocardiogram (ECG) showed manifest but incomplete pre-excitation consistent...
A 45-year-old lady was evaluated for recurrent episodes of palpitation. Her 12‑lead electrocardiogram (ECG) showed manifest but incomplete pre-excitation consistent with left sided accessory pathway. There was no structural heart disease by echocardiogram. She underwent an electrophysiology (EP) study after informed consent. A narrow QRS tachycardia consistent with orthodromic AV re-entry got induced. The accessory pathway was mapped to 2 'O clock of the mitral annulus (MA). While radio frequency ablation (RFA) was being performed at that site, an interesting phenomenon was observed (Figs. 1 & 2). What is the mechanism?
Topics: Accessory Atrioventricular Bundle; Catheter Ablation; Electrocardiography; Female; Humans; Middle Aged; Pre-Excitation Syndromes; Radiofrequency Ablation
PubMed: 33770648
DOI: 10.1016/j.jelectrocard.2021.02.016 -
Kardiologiia 2002
Topics: Animals; Electrocardiography; Humans; Pre-Excitation Syndromes; Ventricular Premature Complexes
PubMed: 12494081
DOI: No ID Found -
Journal of Cardiovascular... Jun 2019
Topics: Accessory Atrioventricular Bundle; Action Potentials; Child; Electrocardiography; Electrophysiologic Techniques, Cardiac; Heart Rate; Humans; Isolated Noncompaction of the Ventricular Myocardium; Male; Pre-Excitation Syndromes; Tachycardia, Supraventricular; Time Factors
PubMed: 30725514
DOI: 10.1111/jce.13871 -
Cardiac Electrophysiology Clinics Dec 2020Despite extensive knowledge of the physiopathology of ventricular pre-excitation, management of asymptomatic patients with this condition remains controversial. (Review)
Review
Despite extensive knowledge of the physiopathology of ventricular pre-excitation, management of asymptomatic patients with this condition remains controversial.
Topics: Asymptomatic Diseases; Catheter Ablation; Death, Sudden, Cardiac; Electrocardiography; Electrophysiologic Techniques, Cardiac; Humans; Pre-Excitation Syndromes
PubMed: 33162001
DOI: 10.1016/j.ccep.2020.08.004 -
European Journal of Pediatrics Aug 2020The prevalence of ventricular pre-excitation is 0.07-0.2% in the pediatric population. Kent bundle is the most common atrioventricular accessory pathway and Mahaim fiber... (Review)
Review
The prevalence of ventricular pre-excitation is 0.07-0.2% in the pediatric population. Kent bundle is the most common atrioventricular accessory pathway and Mahaim fiber is relatively rare. Approximately, 30-60% of children with ventricular pre-excitation have onset of atrioventricular reentrant tachycardia. Persistent atrioventricular reentrant tachycardia can lead to tachycardiomyopathy. The anterograde conduction of right accessory pathway might lead to ventricular systolic dyssynchrony which might result in cardiac dysfunction even in patients with no tachycardia onset. This type of dilated cardiomyopathy was named as accessory pathway-induced dilated cardiomyopathy. Antiarrhythmic drugs can be used to acutely terminate tachycardia or taken orally to decrease tachycardia recurrence in the long term. However, antiarrhythmic drugs that can be chosen for children are quite limited. Sotalol has become a new choice. With the maturation of radiofrequency catheter ablation technique, progress in three-dimensional electro-anatomic mapping, use of cryoablation, and accumulation of experience in children with small age and weight, catheter ablation has become the first choice for children with pre-excitation syndrome.Conclusion: For ventricular pre-excitation co-exists with dilated cardiomyopathy, differential diagnosis of tachycardiomyopathy or accessory pathway-induced dilated cardiomyopathy should be considered. Catheter ablation (radiofrequency and cryoablation) is a relatively safe and effective treatment option and has become the first choice to treat children with ventricular pre-excitation. What is Known: • Persistent atrioventricular reentrant tachycardia in children can lead to tachycardiomyopathy; • Antiarrhythmic drugs that can be chosen for children are quite limited. What is New: • The anterograde conduction of right accessory pathway (not related to supraventricular tachycardia) might lead to accessory pathway-induced dilated cardiomyopathy. • Catheter ablation (including radiofrequency and cryoablation) has become the first choice for children with pre-excitation syndrome.
Topics: Anti-Arrhythmia Agents; Catheter Ablation; Child; Humans; Pre-Excitation Syndromes; Treatment Outcome
PubMed: 32529398
DOI: 10.1007/s00431-020-03701-9 -
Circulation. Arrhythmia and... Jun 2017The majority of available data on the clinical course of patients with ventricular preexcitation in the ECG originates from tertiary centers. We aimed to investigate...
BACKGROUND
The majority of available data on the clinical course of patients with ventricular preexcitation in the ECG originates from tertiary centers. We aimed to investigate long-term outcomes in individuals from a primary care population with electrocardiographic preexcitation.
METHODS AND RESULTS
Digital ECGs from 328 638 primary care patients were collected during 2001 to 2011. We identified 310 individuals with preexcitation (age range, 8-85 years). Data on medication, comorbidity, and outcomes were collected from Danish nationwide registries. The median follow-up time was 7.4 years (quartiles, 4.6-10.3 years). Compared with the remainder of the population, patients with preexcitation had higher adjusted hazards of atrial fibrillation (hazard ratio [HR], 3.12; 95% confidence interval [CI], 2.07-4.70) and heart failure (HR, 2.11; 95% CI, 1.27-3.50). Subgroup analysis on accessory pathway location revealed a higher adjusted hazard of heart failure for a right anteroseptal accessory pathway (HR, 5.88; 95% CI, 2.63-13.1). There was no evidence of a higher hazard of death among individuals with preexcitation when looking across all age groups (HR, 1.07; 95% CI, 0.68-1.68). However, a statistically significant (=0.01) interaction analysis (<65 versus ≥65 years) indicated a higher hazard of death for patients with preexcitation ≥65 years (HR, 1.85; 95% CI, 1.07-3.18).
CONCLUSIONS
In this large ECG study, individuals with preexcitation had higher hazards of atrial fibrillation and heart failure. The higher hazard of heart failure seemed to be driven by a right anteroseptal accessory pathway. Among elderly people, we found a statistically significant association between preexcitation and a higher hazard of death.
Topics: Accessory Atrioventricular Bundle; Action Potentials; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Atrial Fibrillation; Cause of Death; Child; Denmark; Electrocardiography; Female; Heart Conduction System; Heart Failure; Heart Rate; Humans; Male; Middle Aged; Pre-Excitation Syndromes; Predictive Value of Tests; Prevalence; Primary Health Care; Prognosis; Proportional Hazards Models; Registries; Risk Assessment; Risk Factors; Sex Factors; Time Factors; Young Adult
PubMed: 28576781
DOI: 10.1161/CIRCEP.116.004778 -
Annals of Noninvasive Electrocardiology... Sep 2021The patient is a 19 years-old man who often wakes up in dreams with palpitations and fatigue. The ECG shows: 1. Sinus rhythm; 2. Preexcitation syndrome. Transesophageal...
The patient is a 19 years-old man who often wakes up in dreams with palpitations and fatigue. The ECG shows: 1. Sinus rhythm; 2. Preexcitation syndrome. Transesophageal electrophysiological study (TEEPS) diagnosis:High-risk accessory pathway. During radiofrequency catheter ablation, the patient suddenly developed atrial fibrillation and quickly converted to ventricular fibrillation. After defibrillation, ventricular fibrillation is transformed into sinus rhythm. Subsequently, the patient's high-risk accessory pathway was successfully ablated. Studies have shown that about 25% of patients with WPW syndrome have a refractory period of less than 250 ms, which is one of the risk factors for the conversion of atrial fibrillation to ventricular fibrillation. Therefore, risk stratification is recommended for these symptomatic patients. From 1980 to 1990, there were literature reports on risk stratification of patients with preexcitation syndrome by TEEPS. But it has not become a routine examination of risk stratification in patients with preexcitation syndrome.The reason may be related to the hardware conditions and risk stratification methods used at that time. The TEEPS equipment currently used in our hospital can control the pacing voltage at about 12 mv on average. The voltage in this case report is 9 mv only. In addition, we successfully stratified the risk of patient with preexcitation syndrome without inducing atrial fibrillation. All the electrophysiological records of the patient during the examination were recorded simultaneously with the 12-lead ECG and the esophageal lead ECG. These improvements makes TEEPS a simple, safe and reliable non-invasive cardiac electrophysiological detection technology, which is worth popularizing in hospitals.
Topics: Adult; Catheter Ablation; Electrocardiography; Electrophysiologic Techniques, Cardiac; Humans; Male; Pre-Excitation Syndromes; Risk Assessment; Wolff-Parkinson-White Syndrome; Young Adult
PubMed: 34291526
DOI: 10.1111/anec.12882 -
Acta Medica Scandinavica Jul 1951
Topics: Electrocardiography; Heart Rate; Heart Ventricles; Humans; Myocardial Contraction; Pre-Excitation Syndromes; Rheumatic Fever; Rheumatic Heart Disease
PubMed: 14856625
DOI: 10.1111/j.0954-6820.1951.tb10159.x -
Current Problems in Cardiology Apr 1988
Review
Topics: Anti-Arrhythmia Agents; Cardiac Pacing, Artificial; Death, Sudden; Electrocardiography; Heart Conduction System; Humans; Lown-Ganong-Levine Syndrome; Neural Conduction; Neural Pathways; Pre-Excitation Syndromes; Risk Factors; Tachycardia, Atrioventricular Nodal Reentry; Wolff-Parkinson-White Syndrome
PubMed: 3292155
DOI: 10.1016/0146-2806(88)90025-4