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Herzschrittmachertherapie &... Mar 2024The history of surgical treatment of ventricular tachycardias (VT) is short, lasting from 1978 until 1993. "Indirect procedures" with infarct scar resection were... (Review)
Review
[History of surgical treatment of cardiac arrhythmias in Germany : Surgical treatment of ventricular tachycardia and supraventricular tachycardia, especially pre-excitation syndromes (WPW)].
The history of surgical treatment of ventricular tachycardias (VT) is short, lasting from 1978 until 1993. "Indirect procedures" with infarct scar resection were performed without electrophysiologic studies, whereas "direct procedures" consisted of either complete endocardial incisions ("encircling endocardial ventriculotomy") or large endocardial resections ("endocardial peel-off" technique) after precise epicardial and endocardial mapping procedures. In Germany, the first to report on intra-operative electrophysiologic mapping for VT treatment were Ostermeyer, Breithardt and Seipel in 1979. In 1981, the Hannover group (Frank, Klein) published their first results of surgical treatment of VT. In 1984, Ostermeyer et al. demonstrated that a partial endocardial incision resulted in more beneficial results with less myocardial damage (8% versus 46%) than applying a complete encircling incision. In 1987, the Düsseldorf group reported treatment results of 93 patients. After 5 years, 77% had no VT recurrence, while total mortality after 1 year was 11% and after 5 years 30%. In 1992, the Hannover group reported results of 147 patients after endocardial resection for VT. Total mortality after 3 years was 27%; recurrence of VT events occurred in 18% of the surviving cohort.The history of surgical procedures for supraventricular tachycardia (SVT), in particular Wolff-Parkinson-White (WPW) syndrome, is even shorter than that of surgery for VT. As early as 1969, Sealy, Gallagher and Cox reported the first cases of surgical intervention for WPW syndrome via endocardial access in cardioplegic arrest. In 1984, Guiraudon and Klein reported on a new procedure with epicardial access to the accessory bundle without cardioplegia in laterally localised conduction pathways. In Germany, too, the groups in Düsseldorf (Ostermeyer, Seipel, Breithardt, Borggrefe) from 1980 and the Hannover group (Frank, Klein and Kallfelz) from 1981 performed surgical procedures for WPW syndrome. In 1987, Borggrefe reported on 18 patients with WPW syndrome and atrial fibrillation who had undergone surgery. After 2 years, 14 of 18 patients had no recurrences of tachycardia; in 1989, Frank, Klein and Kallfelz (Hannover) reported on 10 children (2-14 years) operated on using the cryoablation technique. Between 1984 and 1992, a total of 120 patients with SVT, mostly WPW syndrome, were operated on in Hannover; after 42 months, 12 patients had a recurrence of SVT. Two patients died during the reoperation.
Topics: Child; Humans; Wolff-Parkinson-White Syndrome; Tachycardia, Supraventricular; Tachycardia, Ventricular; Pre-Excitation Syndromes; Atrial Fibrillation
PubMed: 38416160
DOI: 10.1007/s00399-024-01012-2 -
The American Journal of Case Reports Dec 2021BACKGROUND Pheochromocytoma is a rare catecholamine-secreting tumor arising from chromaffin cells of the adrenal medulla. Wolff-Parkinson-White (WPW) pattern is a rare...
BACKGROUND Pheochromocytoma is a rare catecholamine-secreting tumor arising from chromaffin cells of the adrenal medulla. Wolff-Parkinson-White (WPW) pattern is a rare congenital cardiac conduction disorder in which 1 or more accessory pathways connects the atria and ventricles, bypassing the atrioventricular (AV) node. Patients with this type of accessory pathway who also experience pre-excitation evoked arrhythmias have what is termed WPW syndrome. Here, we present a patient with a WPW pattern who underwent surgical resection of a pheochromocytoma, review considerations relating to the perioperative management, and briefly summarize the hormonal effects of pheochromocytoma in a patient with a WPW accessory pathway. CASE REPORT A man in his early 30's with a history of hypertension developed shortness of breath with palpitations, was noted to have delta waves on electrocardiogram (ECG), and was given a diagnosis of WPW syndrome. Six years later, he developed headache, chest pain, and flank discomfort in addition to his daily palpitations and shortness of breath. Plasma catecholamine levels were measured and found to be elevated, and imaging studies noted the presence of a large right-sided adrenal mass, consistent with a pheochromocytoma. A decision was made to proceed with a laparoscopic right adrenalectomy, which was successful and uneventful. Through the 30-day postoperative period, he reported no further episodes of symptomatic palpitations for the first time in several years. CONCLUSIONS To the best of our knowledge, this is only the fourth case in the literature describing pheochromocytoma with co-existing WPW syndrome. In our case, resection of the pheochromocytoma ameliorated the patient's chronic WPW-related tachyarrhythmia.
Topics: Adrenal Gland Neoplasms; Animals; Electrocardiography; Equidae; Humans; Male; Pheochromocytoma; Wolff-Parkinson-White Syndrome
PubMed: 34866133
DOI: 10.12659/AJCR.934137 -
Journal of the American College of... May 1988
Review
Topics: Diagnosis, Differential; Electrocardiography; Humans; Wolff-Parkinson-White Syndrome
PubMed: 3281993
DOI: 10.1016/s0735-1097(98)90074-2 -
Annals of Noninvasive Electrocardiology... Sep 2014The association between Brugada syndrome (BS) and ventricular preexcitation is a rare condition, with sporadic cases already reported. We report the case of a...
The association between Brugada syndrome (BS) and ventricular preexcitation is a rare condition, with sporadic cases already reported. We report the case of a 29-year-old man, with palpitation unrelated to physical or emotional stress. The electrocardiogram of the first visit revealed a ventricular preexcitation pattern and an end-conduction delay, with negative T wave in V1 and intraventricular conduction disturbance in V2 (atypical for BS). The typical aspect of BS occurred after introduction of propafenone for the prevention of atrioventricular tachycardia. We discuss the recognition of this rare association, the proarrhythmic effects of some drugs, treatment options, and prognosis.
Topics: Adult; Brugada Syndrome; Catheter Ablation; Electrocardiography; Humans; Male; Prognosis; Wolff-Parkinson-White Syndrome
PubMed: 24517421
DOI: 10.1111/anec.12124 -
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 -
The Journal of Clinical Investigation Feb 2011Ventricular preexcitation, a feature of Wolff-Parkinson-White syndrome, is caused by accessory myocardial pathways that bypass the annulus fibrosus. This condition...
Ventricular preexcitation, a feature of Wolff-Parkinson-White syndrome, is caused by accessory myocardial pathways that bypass the annulus fibrosus. This condition increases the risk of atrioventricular tachycardia and, in the presence of atrial fibrillation, sudden death. The developmental mechanisms underlying accessory pathway formation are poorly understood but are thought to primarily involve malformation of the annulus fibrosus. Before birth, slowly conducting atrioventricular myocardium causes a functional atrioventricular activation delay in the absence of the annulus fibrosus. This myocardium remains present after birth, suggesting that the disturbed development of the atrioventricular canal myocardium may mediate the formation of rapidly conducting accessory pathways. Here we show that myocardium-specific inactivation of T-box 2 (Tbx2), a transcription factor essential for atrioventricular canal patterning, leads to the formation of fast-conducting accessory pathways, malformation of the annulus fibrosus, and ventricular preexcitation in mice. The accessory pathways ectopically express proteins required for fast conduction (connexin-40 [Cx40], Cx43, and sodium channel, voltage-gated, type V, α [Scn5a]). Additional inactivation of Cx30.2, a subunit for gap junctions with low conductance expressed in the atrioventricular canal and unaffected by the loss of Tbx2, did not affect the functionality of the accessory pathways. Our results suggest that malformation of the annulus fibrosus and preexcitation arise from the disturbed development of the atrioventricular myocardium.
Topics: Accessory Atrioventricular Bundle; Animals; Atrioventricular Node; Connexin 43; Female; Gene Expression Regulation, Developmental; Heart Conduction System; Humans; Mice; Mice, Inbred C57BL; Mice, Transgenic; Morphogenesis; Myocardium; Pregnancy; T-Box Domain Proteins; Wolff-Parkinson-White Syndrome
PubMed: 21266775
DOI: 10.1172/JCI44350 -
Anesthesiology Jan 1994The effects of volatile agents and sufentanil anesthesia on the electrophysiologic properties of the accessory pathway and on the incidence of intraoperative... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
The electrophysiologic effects of volatile anesthetics and sufentanil on the normal atrioventricular conduction system and accessory pathways in Wolff-Parkinson-White syndrome.
BACKGROUND
The effects of volatile agents and sufentanil anesthesia on the electrophysiologic properties of the accessory pathway and on the incidence of intraoperative tachyarrhythmias in patients with Wolff-Parkinson-White syndrome are unknown. Therefore, we studied these agents for their use in patients undergoing ablative procedures or requiring a general anesthetic for other surgeries.
METHODS
Twenty-one patients with Wolff-Parkinson-White syndrome undergoing surgical ablation were anesthetized with sufentanil (20 micrograms/kg), lorazepam (0.06 mg/kg), and vecuronium (20 mg). After sternotomy, the electrophysiologic study during antegrade stimulation consisted of the effective refractory period of the right atrium, atrioventricular node, and accessory pathway; the shortest cycle length of the atrioventricular node and accessory pathway; and the coupling interval. During retrograde stimulation, the effective refractory period of the right ventricle and accessory pathway and the shortest cycle length of the accessory pathway were measured and compared to preoperative electrophysiologic values. Patients then were randomized to receive 1 MAC of halothane, isoflurane, or enflurane, and the electrophysiologic study was repeated.
RESULTS
Sufentanil-lorazepam caused mild prolongation (P < 0.05) of the effective refractory period of the accessory pathway and the shortest cycle length of the atrioventricular node. Enflurane and isoflurane significantly prolonged all parameters related to refractoriness during antegrade conduction, with enflurane having the largest effect. During retrograde conduction, isoflurane prolonged the effective refractory period of the right ventricle and accessory pathway and the shortest cycle length of the accessory pathway, whereas enflurane prolonged only the accessory pathway effective refractory period and shortest cycle length. Halothane had the least effect on refractoriness, causing significant prolongation of the atrioventricular node effective refractory period and the shortest cycle length of the accessory pathway only during antegrade conduction. The coupling interval, a measure of the period of vulnerability to supraventricular tachycardia, was prolonged only by halothane and isoflurane. Supraventricular tachycardia was still obtainable in all patients.
CONCLUSIONS
Sufentanil-lorazepam has no clinically significant effect on the electrophysiologic expression of the accessory pathway. Of the volatile agents, enflurane most, isoflurane next, and halothane least increased refractoriness within the accessory and atrioventricular pathways. Therefore, administration of these volatile agents during ablative procedures may confound interpretation of postablative studies used to determine the success of ablation treatment. Conversely, in patients with preexcitation syndrome requiring general anesthesia for nonablative procedures, volatile agents may reduce the incidence of perioperative tachyarrhythmias because of their effects on refractoriness. Enflurane would be the agent of choice because it increases refractoriness the most without prolonging the coupling interval.
Topics: Adolescent; Adult; Anesthesia; Atrioventricular Node; Electrophysiology; Enflurane; Female; Halothane; Humans; Isoflurane; Lorazepam; Male; Sufentanil; Wolff-Parkinson-White Syndrome
PubMed: 8291732
DOI: 10.1097/00000542-199401000-00013 -
Journal of Cardiology Oct 2017Limited fluoroscopy ablation using 3D electro-anatomical system (3DS) has been used for arrhythmias in children, however it is not a common practice. We aimed to... (Clinical Trial)
Clinical Trial
BACKGROUND
Limited fluoroscopy ablation using 3D electro-anatomical system (3DS) has been used for arrhythmias in children, however it is not a common practice. We aimed to facilitate a fluoroscopy limited approach for ablation of accessory pathways (AP) in children.
METHODS
Following electrophysiologic (EP) catheter placement a single dual-plane fluoroscopic image (right anterior oblique-30° and left anterior oblique-60° views) was acquired and the 3DS views were rotated to be a perfect match to the fluoroscopy. Ninety-four consecutive pediatric patients [mean age 11.8±4.1 (4.2-18) years, 61.7% males] with Wolf-Parkinson-White syndrome underwent ablation of an AP. Fifty-seven had manifest AP, 54 had left-sided AP (LSAP) and 40 had right-sided AP (RSAP).
RESULTS
The acute success rate was 95.7% (90/94), with a recurrence rate of 1.1% (1/90) at a mean follow-up of 13±5.5 (4.4-22.9) months. Mean procedure and fluoroscopy times were 144±45 (55-262)min and 1.8±1.4 (0.1-5.6)min, respectively. Comparison of the first 20 procedures to the next 74 procedures demonstrated an extended procedure time (171±53min vs 135±38min, p<0.005), however the fluoroscopy time, the number of long applications, the time to effect, and the acute success rate were similar. There were no permanent ablation-related complications.
CONCLUSIONS
A limited fluoroscopy approach for ablation of AP in children using 3DS is easily acquired, adapted, reduces the fluoroscopy time, and has an excellent efficacy and safety profile.
Topics: Accessory Atrioventricular Bundle; Adolescent; Catheter Ablation; Child; Child, Preschool; Female; Fluoroscopy; Humans; Male; Recurrence; Wolff-Parkinson-White Syndrome
PubMed: 28274505
DOI: 10.1016/j.jjcc.2016.12.018 -
BMJ Case Reports Jun 2011A 19-year-old male presented with periorbital cellulitis responsive to intravenous antibiotics. A routine ECG on admission showed slurred upstroke of the QRS complexes... (Review)
Review
A 19-year-old male presented with periorbital cellulitis responsive to intravenous antibiotics. A routine ECG on admission showed slurred upstroke of the QRS complexes consistent with Wolff-Parkinson-White syndrome (WPW). He has never experienced any cardiac-related symptoms. Once the periorbital cellulitis resolved, he was referred to the specialist cardiology ablation clinic. He was counselled on the arrythmogenic risks of untreated WPW and the potential complications of radiofrequency catheter ablation (RFCA). He decided to go ahead with electrophysiological studies and RFCA, which took place successfully. This case highlights the importance of routine ECG in the diagnosis of asymptomatic WPW. The use of prophylactic ablation of asymptomatic WPW is controversial and should be considered on a case-specific basis.
Topics: Asymptomatic Diseases; Catheter Ablation; Electrocardiography; Humans; Incidental Findings; Male; Wolff-Parkinson-White Syndrome; Young Adult
PubMed: 22693197
DOI: 10.1136/bcr.05.2011.4192 -
Journal of the American Veterinary... Sep 2010
Topics: Animals; Anti-Arrhythmia Agents; Cardiac Pacing, Artificial; Dog Diseases; Dogs; Electrocardiography; Fatal Outcome; Male; Wolff-Parkinson-White Syndrome
PubMed: 20839984
DOI: 10.2460/javma.237.6.641