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Journal of Veterinary Cardiology : the... Jun 2023Atrioventricular accessory pathways are abnormal electrical connections between the atria and ventricles that predispose to ventricular pre-excitation (VPE) and...
OBJECTIVES
Atrioventricular accessory pathways are abnormal electrical connections between the atria and ventricles that predispose to ventricular pre-excitation (VPE) and tachycardias.
ANIMALS
Seventeen cats with VPE and 15 healthy matched-control cats.
MATERIAL AND METHODS
Multicenter case-control retrospective study. Clinical records were searched for cats with VPE, defined as preserved atrioventricular synchrony, reduced PQ interval, and increased QRS complex duration with a delta wave. Clinical, electrocardiography, echocardiographic, and outcome data were collated.
RESULTS
Most cats with VPE were male (16/17 cats), non-pedigree cats (11/17 cats). Median age and mean body weight were 5.4 years (0.3-11.9 years) and 4.6 ± 0.8 kg, respectively. Clinical signs at presentation included lethargy (10/17 cats), tachypnea (6/17 cats), and/or syncope (3/17 cats). In two cats, VPE was an incidental finding. Congestive heart failure was uncommon (3/17 cats). Nine (9/17) cats had tachyarrhythmias: 7/9 cats had narrow QRS complex tachycardia and 2/9 cats had wide QRS complex tachycardia. Four cats had ventricular arrhythmias. Cats with VPE had larger left (P < 0.001) and right (P < 0.001) atria and thicker interventricular septum (P = 0.019) and left ventricular free wall (P = 0.028) than controls. Three cats had hypertrophic cardiomyopathy. Treatment included different combinations of sotalol (5/17 cats), diltiazem (5/17 cats), atenolol (4/17 cats), furosemide (4/17 cats), and platelet inhibitors (4/17 cats). Five cats died, all from cardiac death (median survival time 1882 days [2-1882 days]).
CONCLUSIONS
Cats with VPE had a relatively long survival, albeit showing larger atria and thicker left ventricular walls than healthy cats.
Topics: Male; Cats; Animals; Female; Wolff-Parkinson-White Syndrome; Retrospective Studies; Pre-Excitation Syndromes; Tachycardia; Electrocardiography; Cat Diseases
PubMed: 37267820
DOI: 10.1016/j.jvc.2023.04.005 -
International Journal of Emergency... May 2023Wolff-Parkinson-White (WPW) syndrome is a condition characterized by the persistence of an accessory pathway responsible for ventricular pre-excitation that can lead to...
BACKGROUND
Wolff-Parkinson-White (WPW) syndrome is a condition characterized by the persistence of an accessory pathway responsible for ventricular pre-excitation that can lead to symptomatic and potentially severe arrhythmias. Coexistence with atrial fibrillation is well known and not uncommon, exposing to potential degenerescence into ventricular fibrillation when atrial impulses are transmitted along the accessory pathway. WPW syndrome is most prevalent in younger patients and cases revealed after an advanced age have rarely been described in the literature.
CASE PRESENTATION
Here, we report a case of atrial pre-excitation first diagnosed at the age of 72 years that required external electrical cardioversion with a favorable outcome. The diagnosis was based on clinical and electrographic findings.
CONCLUSIONS
WPW syndrome is a relatively rare cardiac disorder that can be a cause of sudden death, especially when combined with atrial fibrillation. Therefore, cardiologists have to consider this diagnosis in patients presenting clinical signs of arrhythmia with an electrical pattern of WPW.
PubMed: 37170212
DOI: 10.1186/s12245-023-00506-z -
Ugeskrift For Laeger Apr 2023A 63-year-old mand with permanent atrial fibrillation through five years presents to the emergency room with dyspnea and an ECG showing pre-excited afib. The ECG was...
A 63-year-old mand with permanent atrial fibrillation through five years presents to the emergency room with dyspnea and an ECG showing pre-excited afib. The ECG was initially perceived as afib with bundle branch block and treated with digoxin. After that, treatment with amiodaron was given; also without success. After DC-conversion, multiple times and relapse, the patient was transferred to a highly specialised hospital, and an accessory pathway was performed ablated. This is a case report of a patient who had permanent atrial fibrillation and whose initial presentation of Wolff-Parkinson White syndrome was pre-excited atrial fibrillation.
Topics: Humans; Middle Aged; Atrial Fibrillation; Electrocardiography; Wolff-Parkinson-White Syndrome; Heart Block
PubMed: 37114581
DOI: No ID Found -
Europace : European Pacing,... May 2023
Topics: Humans; Wolff-Parkinson-White Syndrome; Electrocardiography; Patients; Catheter Ablation
PubMed: 37070604
DOI: 10.1093/europace/euad104 -
Archivos de Cardiologia de Mexico 2023In 1996 Iturralde et al. published an algorithm based on the QRS polarity to determine the location of the accessory pathways (AP), this algorithm was developed before...
BACKGROUND
In 1996 Iturralde et al. published an algorithm based on the QRS polarity to determine the location of the accessory pathways (AP), this algorithm was developed before the massive practice of invasive electrophysiology.
PURPOSE
To validate the QRS-Polarity algorithm in a modern cohort of subjects submitted to radiofrequency catheter ablation (RFCA). Our objective was to determinate its global accuracy and its accuracy for parahisian AP.
METHODS
We conducted a retrospective analysis of patients with Wolff-Parkinson-White (WPW) syndrome who underwent an electrophysiological study (EPS) and RFCA. We employed the QRS-Polarity algorithm to predict the AP anatomical location and we compared this result with the real anatomic location determined in the EPS. To determine accuracy, the Cohen's kappa coefficient (k) and the Pearson correlation coefficient were used.
RESULTS
A total of 364 patients were included (mean age 30 years, 57% male). The global k score was 0.78 and the Pearson's coefficient was 0.90. The accuracy for each zone was also evaluated, the best correlation was for the left lateral AP (k of 0.97). There were 26 patients with a parahisian AP, who showed a great variability in the ECG features. Employing the QRS-Polarity algorithm, 34.6% patients had a correct anatomical location, 42.3% had an adjacent location and only 23% an incorrect location.
CONCLUSION
The QRS-Polarity algorithm has a good global accuracy; its precision is high, especially for left lateral AP. This algorithm is also useful for the parahisian AP.
Topics: Humans; Male; Adult; Female; Retrospective Studies; Electrocardiography; Wolff-Parkinson-White Syndrome; Accessory Atrioventricular Bundle; Algorithms; Catheter Ablation
PubMed: 37054739
DOI: 10.24875/ACM.22000090 -
JACC. Clinical Electrophysiology Mar 2023
Topics: Humans; Atrial Fibrillation; Takotsubo Cardiomyopathy; Wolff-Parkinson-White Syndrome
PubMed: 36990599
DOI: 10.1016/j.jacep.2023.01.036 -
Journal of Medical Case Reports Mar 2023Wolff-Parkinson-White syndrome is characterized by a short PR interval (delta-wave), long QRS complex, and the appearance of paroxysmal supraventricular tachycardia....
BACKGROUND
Wolff-Parkinson-White syndrome is characterized by a short PR interval (delta-wave), long QRS complex, and the appearance of paroxysmal supraventricular tachycardia. Patients with Wolff-Parkinson-White syndrome usually have one accessory pathway, whereas cases with multiple accessory pathways are rare. Persistent left superior vena cava is a vascular anomaly in which the vein drains into the right atrium through the coronary sinus at the junction of the left internal jugular and subclavian veins due to abnormal development of the left cardinal vein. The simultaneous presence of multiple accessory pathways and persistent left superior vena cava has not been reported before.
CASE PRESENTATION
A 56-year-old Japanese man with a 5-year history of palpitations was referred for radiofrequency catheter ablation due to increased frequency of tachycardia episodes in the previous 2 months. Persistent left superior vena cava was confirmed by transthoracic echocardiography and computed tomography. An electrophysiological study revealed that the accessory pathways were located in the left lateral wall, anterolateral wall, and posteroseptal region. They were completely ablated with radiofrequency energy application.
CONCLUSIONS
We reported an extremely rare case of a patient with multiple accessory pathways and persistent left superior vena cava. Our case may suggest a potential embryological relationship between the multiple accessory pathways and persistent left superior vena cava.
Topics: Male; Humans; Middle Aged; Wolff-Parkinson-White Syndrome; Persistent Left Superior Vena Cava; Vena Cava, Superior; Electrocardiography; Echocardiography
PubMed: 36967399
DOI: 10.1186/s13256-023-03865-6 -
Journal of the American College of... Mar 2023Nonischemic cardiomyopathies are a frequent occurrence. The understanding of the mechanism(s) and triggers of these cardiomyopathies have led to improvement and even... (Review)
Review
Nonischemic cardiomyopathies are a frequent occurrence. The understanding of the mechanism(s) and triggers of these cardiomyopathies have led to improvement and even recovery of left ventricular function. Although chronic right ventricular pacing-induced cardiomyopathy has been recognized for many years, left bundle branch block and pre-excitation have been recently identified as potential reversible causes of cardiomyopathy. These cardiomyopathies share a similar abnormal ventricular propagation that can be recognized by a wide QRS duration with left bundle branch block pattern; thus, we coined the term abnormal conduction-induced cardiomyopathies. Such abnormal propagation results in an abnormal contractility that can only be recognized by cardiac imaging as ventricular dyssynchrony. Appropriate diagnosis and treatment will not only lead to improved left ventricular ejection fraction and functional class, but may also reduce morbidity and mortality. This review presents an update of the mechanisms, prevalence, incidence, and risk factors, as well as their diagnosis and management, while highlighting current gaps of knowledge.
Topics: Humans; Bundle-Branch Block; Stroke Volume; Ventricular Function, Left; Cardiac Conduction System Disease; Cardiomyopathies; Arrhythmias, Cardiac; Treatment Outcome
PubMed: 36948737
DOI: 10.1016/j.jacc.2023.01.040 -
Journal of Cardiology Cases Mar 2023A 52-year-old man presented with delta waves on a body surface electrocardiogram, which suggested the presence of a right-sided accessory pathway (AP). Patients with...
Unusual QRS complexes associated with the simultaneous presence of a right-sided accessory pathway, fasciculoventricular pathway, and incomplete right bundle branch block.
UNLABELLED
A 52-year-old man presented with delta waves on a body surface electrocardiogram, which suggested the presence of a right-sided accessory pathway (AP). Patients with right-sided APs generally have an rS pattern in leads V1-2, while he had an rS in lead V1 but an Rs in lead V2, which could not rule out the possibility of the presence of a septal AP or fasciculoventricular pathway (FVP). On the other hand, patients with septal APs or FVPs generally have a QS pattern in lead V1 instead of an rS pattern. An electrophysiological study demonstrated that the simultaneous presence of a right-sided posterolateral AP and FVP with incomplete right bundle branch block (ICRBBB) generated those unusual QRS complexes. The FVP arose distal to the site with ICRBBB, and the ICRBBB delayed the initiation of the FVP conduction. The delayed QS and Rs waves in leads V1-2 generated by the FVP conduction with ICRBBB appeared to produce rS and Rs patterns in leads V1-2, respectively. A radiofrequency application along the posterolateral tricuspid annulus eliminated the right-sided AP conduction. If the localization of APs based on the QRS morphology is difficult, multiple APs or an FVP with a conduction system disturbance should be noted.
LEARNING OBJECTIVE
Patients with right-sided posterolateral accessory pathways (APs) generally have an rS pattern in lead V2, while patients with fasciculoventricular pathways (FVPs) generally have a QS pattern in lead V1. The present case with a suspected right-sided posterolateral AP had unusual QRS complexes, an rS in lead V1, Rs in lead V2, and monophasic R in leads V3-6, which were associated with the simultaneous presence of a right-sided posterolateral AP, FVP, and incomplete right bundle branch block.
PubMed: 36910041
DOI: 10.1016/j.jccase.2022.10.015 -
Ugeskrift For Laeger Feb 2023In this case report, a previously asymptomatic 11-year-old boy presented with sudden palpitations and syncope. He eventually went into cardiac arrest and was...
In this case report, a previously asymptomatic 11-year-old boy presented with sudden palpitations and syncope. He eventually went into cardiac arrest and was successfully resuscitated. The ECG showed pre-excited atrial fibrillation degenerating into pulseless ventricular tachycardia. The patient was found to have Wolff-Parkinson-White syndrome (WPW) with an accessory pathway between right atrium and ventricle which was successfully ablated. Sudden cardiac death (SCD) is rare in WPW, however, early diagnosis is essential for eliminating the risk of SCD.
Topics: Male; Humans; Child; Wolff-Parkinson-White Syndrome; Heart Arrest; Death, Sudden, Cardiac; Atrial Fibrillation; Syncope; Electrocardiography
PubMed: 36892318
DOI: No ID Found