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Annals of Noninvasive Electrocardiology... Sep 2022One-to-one atrioventricular conduction during atrial flutter is one of the most severe life-threatening arrhythmias and is hemodynamically perilous. Rapid wide QRS...
One-to-one atrioventricular conduction during atrial flutter is one of the most severe life-threatening arrhythmias and is hemodynamically perilous. Rapid wide QRS tachycardia often not only occurs in patients with ventricular tachycardia but is also found in supraventricular tachycardia/atrial flutter with preexistent QRS prolongation, supraventricular tachycardia/atrial flutter with QRS prolongation caused by an IC antiarrhythmic drug, and supraventricular tachycardia/atrial flutter with preexcitation. Furthermore, atrial flutter with 1:1 AVC via an accessory pathway is an uncommon presentation of Wolff-Parkinson-White syndrome. We present a case of atrial flutter with 1:1 rapid AVC in the presence of Wolff-Parkinson-White syndrome. Physicians should be familiar with the rapid wide QRS complex ECG pattern associated with AFL with 1:1 AVC via an accessory pathway. Establishing the definitive diagnosis is essential for selecting an appropriate treatment strategy for improving outcomes.
Topics: Accessory Atrioventricular Bundle; Anti-Arrhythmia Agents; Atrial Flutter; Electrocardiography; Humans; Tachycardia, Supraventricular; Wolff-Parkinson-White Syndrome
PubMed: 35429345
DOI: 10.1111/anec.12959 -
Journal of Cardiothoracic Surgery Mar 2022Radiofrequency catheter ablation is considered to be a relatively safe procedure. This is an unusual case report in which severe mitral regurgitation was occurred after...
BACKGROUND
Radiofrequency catheter ablation is considered to be a relatively safe procedure. This is an unusual case report in which severe mitral regurgitation was occurred after left lateral accessory pathway radiofrequency catheter ablation.
CASE PRESENTATION
A 15-year-old man without structural heart disease was referred for ablation of a left lateral accessory pathway. He was a rugby player who had lived with Wolff-Parkinson-White syndrome since 2017. In 2017, two failed extensive radiofrequency catheter ablations of a left lateral accessory pathway had been performed in another center. In June 2018, he underwent a third radiofrequency catheter ablation of a left lateral accessory pathway using an anterograde transseptal approach with an early recurrence one month later. A successful fourth procedure was performed in August 2018 using a retrograde aortic approach. Three months later, the patient presented to the hospital with atypical chest pain and dyspnea on exertion. Transthoracic echocardiography revealed severe mitral regurgitation caused by a perforation of the posterior leaflet. Given the symptoms and the severity of the mitral valve regurgitation, the decision was taken to proceed with surgical intervention. Posterior mitral leaflet perforation was confirmed intraoperatively. The patient underwent video-assisted mitral valve repair via Minithoracotomy approach.
CONCLUSION
This case demonstrates a very rare complication of Wolff-Parkinson-White radiofrequency ablation.
Topics: Adolescent; Catheter Ablation; Catheters; Heart Injuries; Humans; Male; Mitral Valve; Wolff-Parkinson-White Syndrome
PubMed: 35255938
DOI: 10.1186/s13019-021-01710-9 -
Arquivos Brasileiros de Cardiologia Jan 2022
Topics: AMP-Activated Protein Kinases; Heart Diseases; Humans; Mutation; Wolff-Parkinson-White Syndrome
PubMed: 35195217
DOI: 10.36660/abc.20210062 -
Kardiologia Polska 2022
Topics: Accessory Atrioventricular Bundle; Algorithms; Catheter Ablation; Electrocardiography; Electrophysiology; Humans; Laboratories; Wolff-Parkinson-White Syndrome
PubMed: 35137944
DOI: 10.33963/KP.a2022.0024 -
Journal of Investigative Medicine High... 2022A 79-year-old Caucasian male was referred to cardiology clinic because the electrocardiogram showed premature atrial complexes and pre-excitation (delta waves) thought...
A 79-year-old Caucasian male was referred to cardiology clinic because the electrocardiogram showed premature atrial complexes and pre-excitation (delta waves) thought to be consistent with Wolff-Parkinson-White (WPW) syndrome. He did not report symptoms of palpitations or syncope. Careful analysis of the electrocardiogram revealed a fascicular-ventricular pathway (FVP) responsible for pre-excitation. Differentiating FVP from WPW syndrome is essential as the risk profile is different with each. Electrocardiographic observations that could help identify the presence of an FVP and its diagnostic, prognostic, and therapeutic implications are presented.
Topics: Aged; Electrocardiography; Heart Ventricles; Humans; Male; Pre-Excitation Syndromes; Syncope; Wolff-Parkinson-White Syndrome
PubMed: 35045738
DOI: 10.1177/23247096211073261 -
The Journal of International Medical... Jan 2022To present the authors' experience of Mahaim-type accessory pathways (MAPs), focusing on anatomic localizations.
OBJECTIVE
To present the authors' experience of Mahaim-type accessory pathways (MAPs), focusing on anatomic localizations.
METHODS
Data from consecutive patients who underwent electrophysiological study (EPS) for MAP ablation in two tertiary centres, between January 1998 and June 2020, were retrospectively analysed.
RESULTS
Of the 55 included patients, 27 (49.1%) were male, and the overall mean age was 29.5 ± 11.6 years (range, 12-66 years). MAPs were ablated at the tricuspid annulus in 43 patients (78.2%), mitral annulus in four patients (7.3%), paraseptal region in three patients (5.5%), and right ventricle mid-apical region in five patients (9.1%). Among 49 patients who planned for ablation therapy, the success rate was 91.8% (45 patients).
CONCLUSION
MAPs were most often ablated at the lateral aspect of the tricuspid annuli, sometimes at other sides of the tricuspid and mitral annuli, and infrequently in the right ventricle. The M potential mapping technique is likely to be a useful target for ablation of MAPs.
Topics: Adolescent; Adult; Catheter Ablation; Electrocardiography; Heart Ventricles; Humans; Male; Mitral Valve; Pre-Excitation, Mahaim-Type; Retrospective Studies; Young Adult
PubMed: 35001697
DOI: 10.1177/03000605211069751 -
Annals of Noninvasive Electrocardiology... May 2022Fasciculoventricular pathways (FVPs) are variants of pre-excitation syndrome which were investigated insufficiently because of its rarity.
BACKGROUND
Fasciculoventricular pathways (FVPs) are variants of pre-excitation syndrome which were investigated insufficiently because of its rarity.
OBJECTIVE
This report aimed to represent one of the largest series of FVP, focusing on its clinical and electrophysiological properties.
METHODS
We analyzed retrospectively 26 consecutive patients who underwent electrophysiological study (EPS) for FVP between January 1998 and June 2020.
RESULTS
Among 1437 patients with accessory pathways, 26 had FVP (1.80%). All the 26 patients (100%) were males, with a mean age of 22.15 ± 3.50 years (range, 20-34 years). In the baseline electrocardiograms of the patients with FVP, pre-excitation and transitional zone were seen in leads V -V . During EPS procedures, normal AH interval and shortened HV interval were detected. All the patients had AH prolongation after atrial pacing due to atrioventricular (AV) nodal delay without change in pre-excitation degree. Five of the FVP patients (19.2%) had extra accessory pathways, all of which were ablated successfully while the FVPs were followed clinically.
CONCLUSION
Fasciculoventricular pathways are uncommon variants of pre-excitation syndrome; therefore, they should be diagnosed correctly and followed up noninvasively to avoid damages.
Topics: Accessory Atrioventricular Bundle; Adolescent; Adult; Atrioventricular Node; Electrocardiography; Female; Humans; Male; Pre-Excitation Syndromes; Retrospective Studies; Young Adult
PubMed: 34974635
DOI: 10.1111/anec.12913 -
Archivos Peruanos de Cardiologia Y... 2021This study aims to describe the clinical, electrophysiological and therapeutic characteristics of pediatric patients with supraventricular tachycardia undergoing...
OBJECTIVE
This study aims to describe the clinical, electrophysiological and therapeutic characteristics of pediatric patients with supraventricular tachycardia undergoing radiofrequency ablation.
MATERIALS AND METHODS
Observational, descriptive, retrospective study of children admitted for supraventricular tachycardia treatment at the Instituto Nacional de Salud del Niño during 2018 to 2021.
RESULTS
Data from 62 procedures were collected, corresponding to 59 patients (mean age: 9.91 years, 61% male), 23% of procedures were performed in patients under 15kg, and two were in patients under 5kg. 63% of patients had a structurally normal heart, while 37% had some type of congenital heart disease, the most common being Ebstein's anomaly. The most widely used group of drugs were beta-blockers, mainly propranolol. Among the arrhythmias treated, 21.7% had preexcitation Syndrome, 33.3% had at least one hidden accessory pathway, 5% corresponded to permanent reciprocating junctional tachycardia, 5% intranodal tachycardia, 11.7% atrial tachycardia, 10 % atrial flutter, 5% had other types of tachycardia and in 5 cases no tachycardia was induced. Of the total procedures, 76% corresponded to electrophysiological study and ablation, four patients recurred.
CONCLUSIONS
The most common supraventricular tachycardia substrate in children was the presence of some accessory pathway. Radiofrequency catheter ablation could be applied in children with a high success rate and a low complication rate.
PubMed: 37727670
DOI: 10.47487/apcyccv.v2i4.167 -
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 -
European Heart Journal. Case Reports Dec 2021Atrial fibrillation in WolffParkinsonWhite syndrome may result in life-threateningly rapid antegrade conduction over a bypass tract, manifested by an irregular...
Old stuff still trending: use of propafenone as a safety net until catheter ablation in a patient with documented pre-excited atrial fibrillation and Wolff-Parkinson-White syndrome - a classic case report.
BACKGROUND
Atrial fibrillation in WolffParkinsonWhite syndrome may result in life-threateningly rapid antegrade conduction over a bypass tract, manifested by an irregular broad-complex (pre-excited) tachycardia that can degenerate to ventricular fibrillation. The shortest pre-excited RR interval below 250 ms during atrial fibrillation (AF) predicts increased risk of sudden cardiac death.
CASE SUMMARY
We report a case of a 43-year-old man with unremarkable cardiac history who presented due to sudden-onset feeling of palpitations and pre-syncope after strenuous lifting. Electrocardiography depicted fast pre-excited AF. The shortest pre-excited RR interval was estimated at 160 ms, indicating an accessory pathway (AP) with short antegrade refractory period at risk for mediating sudden cardiac death. Direct current cardioversion restored sinus rhythm unravelling delta waves. The patient was put on propafenone 450 mg/day having an uneventful clinical course. On Day 10 post-admission, electrophysiological study induced rapid AF but the shortest pre-excited RR interval was substantially increased to 264 ms. A left anterolateral AP was ablated. The patient remained symptom free until his latest follow-up in the 3rd-month post-ablation without manifest pre-excitation on the surface electrocardiogram.
DISCUSSION
Treatment options of pre-excited AF include anti-arrhythmic agents but mainly electrical cardioversion. Cardioversion can safely restore sinus rhythm, while use of anti-arrhythmics often requires intensive care unit monitoring due to the risk of QT prolongation. Catheter ablation is the mainstay of therapy for symptomatic patients. Our rare report highlights the direct impact of propafenone on prolonging the refractoriness of the AP, effectively and safely, and reappraises propafenone's worthiness as a protective measure following pre-excited AF episode until ablation.
PubMed: 34909576
DOI: 10.1093/ehjcr/ytab485