-
Journal of Electrocardiology 2021
Topics: Electrocardiography; Humans; Pre-Excitation Syndromes; Takotsubo Cardiomyopathy
PubMed: 33992826
DOI: 10.1016/j.jelectrocard.2021.03.007 -
Annales de Cardiologie Et D'angeiologie Apr 2014The purpose of the study was to look for the prevalence, significance and management of preexcitation syndrome (PS) or symptoms reappearance after accessory pathway (AP)...
AIM
The purpose of the study was to look for the prevalence, significance and management of preexcitation syndrome (PS) or symptoms reappearance after accessory pathway (AP) ablation. AP ablation actually is the first treatment of PS.
METHODS
Successful AP ablation was performed in 261 patients; reappearance of symptoms or PS on ECG occurred in 47 patients (18%) from 20minutes to several years. Their data were compared with remaining patients.
RESULTS
Recurrences were more frequent in patients with spontaneous malignant form (34 vs. 21%), in congenital heart disease (4.2 vs. 0%) (P<0.002), in case of complication (11 vs. 2%) (P<0.007) and of a longer duration of applications (304±209 vs. 188±182sec) (P<0.019). Forty percent of patients had the same symptoms and electrophysiological data as before ablation. Twenty-four percent had an improvement of symptoms and/or electrophysiological data. However, 3 initially asymptomatic patients became symptomatic after ablation. Twenty-six percent had another AP or another rhythm disorder. We recommend transesophageal electrophysiological study for the control because only 40% of patients required second ablation.
CONCLUSIONS
Reappearance of symptoms or a PS on ECG after AP ablation was not rare (18%) and was inconsistently associated with the reappearance of all initial AP electrophysiological properties. Only 40% of patients required a second AP ablation. Another arrhythmia was possible. Non-invasive second evaluation should be preferred. However, asymptomatic patients before ablation could become symptomatic.
Topics: Adolescent; Adult; Aged; Catheter Ablation; Child; Electrocardiography; Female; France; Heart Conduction System; Humans; Male; Middle Aged; Pre-Excitation Syndromes; Prevalence; Recurrence; Risk Factors; Treatment Outcome
PubMed: 24613003
DOI: 10.1016/j.ancard.2014.01.009 -
Annals of Noninvasive Electrocardiology... Apr 2011Resting electrocardiogram is a routine procedure for the identification of potentially fatal conditions, including preexcitation syndrome (PES). Intravenous adenosine is...
BACKGROUND
Resting electrocardiogram is a routine procedure for the identification of potentially fatal conditions, including preexcitation syndrome (PES). Intravenous adenosine is a sensitive and specific means of exposing inapparent pathways in such patients. Yet, it may not be sensitive when complete atrioventricular (AV) block is not achieved because a low dose of adenosine is used. We evaluated the yield of a high-dose adenosine test that achieved complete AV nodal block for unmasking inapparent pathway in a healthy population.
METHODS
We retrospectively reviewed all Israeli air force (IAF) academy candidates who were referred to adenosine test based on a cardiologist's suspicion of PES. The results of the adenosine test were recorded, including the adenosine dose required to achieve complete AV block. The medical records of the subjects were reviewed to identify any adverse cardiovascular outcome.
RESULTS
Fifty-nine subjects who underwent adenosine test were followed for 35.42 ± 24 months. Complete AV block was achieved in all subjects with an average adenosine dose of 22.51 ± 12.67 mg. None of the subjects had evidence of an inapparent pathway. All subjects completed military service without adverse outcomes.
CONCLUSIONS
The vast majority of young patients with a short PR interval do not have evidence of an accessory pathway and have a favorable prognosis. Thus, the yield of adenosine test in young combat recruits is questionable. Yet, if there is no evidence of an accessory pathway while achieving complete AV block on adenosine test, the chance of an accessory pathway being present is probably extremely low.
Topics: Adenosine; Adolescent; Atrioventricular Block; Electrocardiography; Humans; Male; Military Personnel; Pre-Excitation Syndromes; Retrospective Studies; Vasodilator Agents
PubMed: 21496169
DOI: 10.1111/j.1542-474X.2011.00427.x -
The American Journal of Cardiology May 1987Ventricular preexcitation, as seen in Wolff-Parkinson-White syndrome, results in a high frequency of positive exercise electrocardiographic responses. Why this occurs is...
Ventricular preexcitation, as seen in Wolff-Parkinson-White syndrome, results in a high frequency of positive exercise electrocardiographic responses. Why this occurs is unknown but is not believed to reflect myocardial ischemia. Exercise thallium testing is often used for noninvasive assessment of coronary artery disease in patients with conditions known to result in false-positive electrocardiographic responses. To assess the effects of ventricular preexcitation on exercise thallium testing, 8 men (aged 42 +/- 4 years) with this finding were studied. No subject had signs or symptoms of coronary artery disease. Subjects exercised on a bicycle ergometer to a double product of 26,000 +/- 2,000 (+/- standard error of mean). All but one of the subjects had at least 1 mm of ST-segment depression. Tests were terminated because of fatigue or dyspnea and no patient had chest pain. Thallium test results were abnormal in 5 patients, 2 of whom had stress defects as well as abnormally delayed thallium washout. One of these subjects had normal coronary arteries on angiography with a negative ergonovine challenge, and both had normal exercise radionuclide ventriculographic studies. Delayed thallium washout was noted in 3 of the subjects with ventricular preexcitation and normal stress images. This study suggests that exercise thallium testing is frequently abnormal in subjects with ventricular preexcitation. Ventricular preexcitation may cause dyssynergy of ventricular activation, which could alter myocardial thallium handling, much as occurs with left bundle branch block. Exercise radionuclide ventriculography may be a better test for noninvasive assessment of coronary artery disease in patients with ventricular preexcitation.
Topics: Adult; Electrocardiography; Exercise Test; Heart; Humans; Male; Middle Aged; Pre-Excitation Syndromes; Radioisotopes; Radionuclide Imaging; Thallium; Wolff-Parkinson-White Syndrome
PubMed: 3578050
DOI: 10.1016/0002-9149(87)90856-3 -
Kardiologia Polska Jun 2007Atrioventricular reentrant tachycardia (AVRT) is the most common tachycardia, accounting for 70% of regular narrow-QRS arrhythmias in children. Because of the potential... (Clinical Trial)
Clinical Trial Comparative Study
BACKGROUND
Atrioventricular reentrant tachycardia (AVRT) is the most common tachycardia, accounting for 70% of regular narrow-QRS arrhythmias in children. Because of the potential disadvantages of a life-long drug therapy and relatively favourable results from radiofrequency catheter ablation (RFCA) therapy in adults, the indications for ablation therapy in children with preexcitation syndrome (PS) need to be considered.
AIM
To assess efficacy and safety of RFCA in children and adolescents with PS.
METHODS
The study population consisted of 302 consecutive, symptomatic, drug-refractory patients with PS undergoing RFCA. Two age groups were selected: 52 patients younger than 19 years (24 females, age 15.38+/-2.53 years); and 250 adults (115 females, age 38.67+/-13.1 years). In all study patients electrophysiological study and radiofrequency catheter ablation were performed. Comparative analysis between groups was performed with respect to procedure duration, fluoroscopy exposure time, location of accessory pathways (AP), success rate, recurrences and complications.
RESULTS
No significant differences between the groups were noted with respect to procedure duration and exposure time. Success and recurrence rates did not differ between the two-age groups. The mean procedure time for children was 124.12+/-43.48 min (range 45-285) and for adults - 126.3+/-61.49 min (range 25-330) (NS). The mean fluoroscopy time for children was 27.95+/-16.86 min (range 4-75) and for adults - 31.27+/-25.51 min (range 1-131) (NS). The initial RF ablation procedure was successful in 48 (92.31%) children and in 233 (93.2%) adults (NS). Recurrence rate was 12.5% (6 patients) in children vs. 8.58% (20 patients) in adults (NS). In one child (1.92%) and in two adult patients (0.8%) serious complication occurred (NS). Electrophysiological study revealed significantly more frequent presence of the right free wall and right antero-septal AP in children than in adults (21.15 vs. 7.6%, and 17.31 vs. 5.2%, respectively, p <0.01). In adults more frequent left antero-lateral AP was detected: 32.4 vs. 7.69%, p <0.01.
CONCLUSIONS
Radiofrequency catheter ablation is a safe and efficient procedure in paediatric patients with preexcitation syndrome. Effectiveness, safety, recurrence rate and RFCA procedural aspects, including total procedure time and fluoroscopy time, are comparable in paediatric patients with PS and in adults.
Topics: Adolescent; Adult; Catheter Ablation; Child; Electrocardiography; Female; Heart Conduction System; Humans; Male; Pre-Excitation Syndromes; Risk Factors; Tachycardia, Atrioventricular Nodal Reentry; Treatment Outcome
PubMed: 17629826
DOI: No ID Found -
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 -
Heart Rhythm Jul 2021Studies have suggested that a fasciculoventricular pathway (FVP) may be the cause of preexcitation in patients with Danon disease, a rare X-linked dominant genetic...
BACKGROUND
Studies have suggested that a fasciculoventricular pathway (FVP) may be the cause of preexcitation in patients with Danon disease, a rare X-linked dominant genetic disorder of hypertrophic cardiomyopathy.
OBJECTIVE
The purpose of this study was to describe the prevalence of ventricular preexcitation on resting 12-lead electrocardiogram (ECG) in patients with Danon disease and the electrophysiological study (EPS) results of those with preexcitation.
METHODS
Patients with confirmed Danon disease diagnosed with preexcitation (PR ≤120 ms, delta wave, QRS >110 ms) on ECG were included from a multicenter registry. The incidence of arrhythmias, implantable cardioverter-defibrillator (ICD) procedures, ICD shocks, and EPS results were collected.
RESULTS
Thirteen of 40 patients (32.5%) with Danon disease were found to have preexcitation (mean age 17.3 years; 38% women). EPS performed in 9 of 13 patients (69%) demonstrated FVP only in 2 (22.2%), extranodal pathway without exclusion of FVP in 2 (22.2%), and both FVP and extranodal pathway in 5 (55.6%). Two patients had malignant accessory pathway (AP) properties. Over median follow-up of 842 days (interquartile range 138-1678), 11 patients (85%) had ICD placement, and 6 (46.1%) underwent heart transplantation. No patients required therapy for ventricular tachycardia, and 2 patients (15%) had paroxysmal atrial fibrillation.
CONCLUSION
In a large multicenter cohort of patients with Danon disease, there was a high prevalence of FVP and extranodal pathways diagnosed on EPS in those with preexcitation. These findings suggest patients with preexcitation and Danon disease should undergo EPS to assess for FVP and potentially malignant extranodal AP.
Topics: Accessory Atrioventricular Bundle; Adolescent; Adult; Bundle of His; Child; DNA; DNA Mutational Analysis; Electrocardiography; Female; Follow-Up Studies; Glycogen Storage Disease Type IIb; Humans; Incidence; Lysosomal-Associated Membrane Protein 2; Male; Mutation; Pre-Excitation Syndromes; Prevalence; Registries; Retrospective Studies; Time Factors; United States; Young Adult
PubMed: 33737230
DOI: 10.1016/j.hrthm.2021.03.024 -
Heart Rhythm Nov 2014
Topics: Accessory Atrioventricular Bundle; Diagnosis, Differential; Electrocardiography; Exercise Test; Humans; Male; Pre-Excitation Syndromes; Young Adult
PubMed: 24997403
DOI: 10.1016/j.hrthm.2014.07.002 -
Journal of Interventional Cardiac... Jul 2005A patient who had been previously diagnosed with congenital complete atrioventricular block (CCAVB) twenty years ago developed atrioventricular (AV) conduction through...
A patient who had been previously diagnosed with congenital complete atrioventricular block (CCAVB) twenty years ago developed atrioventricular (AV) conduction through an accessory pathway (AP). With enhanced sympathetic tone (exercise, isoproterenol), 1:1 conduction down the AP occurred. An electrophysiologic study confirmed a suprahissian AV block and the presence of an AP. The AP was located on the left side and posterior. The absence of retrograde conduction through the AP and also a long conduction time were demonstrated.
Topics: Adult; Atrioventricular Node; Cardiac Pacing, Artificial; Electrocardiography; Electrophysiologic Techniques, Cardiac; Female; Heart Block; Heart Conduction System; Heart Defects, Congenital; Humans; Pre-Excitation Syndromes
PubMed: 16133844
DOI: 10.1007/s10840-005-0262-9 -
Heart (British Cardiac Society) Sep 2020
Topics: Action Potentials; Adult; Atrial Fibrillation; Bundle-Branch Block; Electrocardiography; Electrophysiologic Techniques, Cardiac; Female; Heart Conduction System; Heart Rate; Humans; Pre-Excitation Syndromes; Predictive Value of Tests
PubMed: 32788290
DOI: 10.1136/heartjnl-2020-316996