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La Tunisie MedicaleEbstein's disease (ED) is a rare and heterogeneous congenital heart disease affecting the tricuspid valve and the right ventricle. Few studies have analyzed the...
INTRODUCTION
Ebstein's disease (ED) is a rare and heterogeneous congenital heart disease affecting the tricuspid valve and the right ventricle. Few studies have analyzed the electrocardiographic features of this disease.
AIM
To describe the electrocardiographic features observed in Ebstein's disease.
METHODS
We conducted a retrospective descriptive study that enrolled 26 patients followed for ED.
RESULTS
The mean age of discovery of the ME was 103.5±99 months [0-31 years]. The diagnosis of ME is most often made between 5 and 10 years. We noted right atrial hypertrophy in 11 patients (42%), right ventricular hypertrophy in half of the patients. Right axial deviation was noted in 11 patients (42%). Eight patients (30%) had wide QRS≥ 120 ms. Seven of these 8 patients (27%) had a fragmented QRS appearance. A right bandle block was noted in 22 patients (84%), it was a complete block in 7 cases (27%). A preexcitation was found in 6 patients (23%). The localization of accessory pathway was right postero-septal in all cases. Rhythmic disorders were noted in 9 patients (34%). It was a junctional tachycardia in 3 patients (11%), atrial flutter in 4 patients (15%) and atrial fibrillation in 2 patients (7%). A second degree atriventricular block was observed in one patient, it was Mobitz I type. Two cases of postoperative rhythm disturbances were recorded: paroxysmal atrial fibrillation and junctional tachycardia related to Wolf Parkinson White (WPW) syndrome.
CONCLUSION
Surface ECG in the ED is often pathological with prevalence of rhythm disturbances related to WPW syndrome.
Topics: Atrial Fibrillation; Ebstein Anomaly; Humans; Retrospective Studies; Tricuspid Valve; Wolff-Parkinson-White Syndrome
PubMed: 35244913
DOI: No ID Found -
Journal of Cardiovascular Medicine... Sep 2023Overt or concealed accessory pathways are the anatomic substrates of ventricular preexcitation (VP), Wolff-Parkinson-White syndrome (WPW) and paroxysmal supraventricular... (Review)
Review
Overt or concealed accessory pathways are the anatomic substrates of ventricular preexcitation (VP), Wolff-Parkinson-White syndrome (WPW) and paroxysmal supraventricular tachycardia (PSVT). These arrhythmias are commonly observed in pediatric age. PSVT may occur at any age, from fetus to adulthood, and its symptoms range from none to syncope or heart failure. VP too can range from no symptoms to sudden cardiac death. Therefore, these arrhythmias frequently need risk stratification, electrophysiologic study, drug or ablation treatment. In this review of the literature, recommendations are given for diagnosis and treatment of fetal and pediatric age (≤12 years) WPW, VP, PSVT, and criteria for sport participation.
Topics: Humans; Child; Infant, Newborn; Infant; Child, Preschool; Wolff-Parkinson-White Syndrome; Accessory Atrioventricular Bundle; Electrocardiography; Tachycardia, Paroxysmal; Tachycardia, Ventricular; Fetus
PubMed: 37409656
DOI: 10.2459/JCM.0000000000001484 -
Romanian Journal of Anaesthesia and... Oct 2018Patients with pre-excitation abnormalities are at a high risk for life-threatening perioperative arrhythmias. In Wolff-Parkinson-White syndrome, the anaesthetics used... (Review)
Review
Patients with pre-excitation abnormalities are at a high risk for life-threatening perioperative arrhythmias. In Wolff-Parkinson-White syndrome, the anaesthetics used for invasive diagnostic testing/ablation, should not affect cardiac electrophysiology; propofol, sevoflurane, fentanyl, sufentanil, alfentanil are suitable. In non-ablative surgery, propofol, sevoflurane, isoflurane, fentanyl, alfentanil, sufentanil have been used safely. Among neuromuscular blockers, cis-atracurium, rocuronium and vecuronium are good choices. Ketamine, pancuronium and pethidine should be avoided because of their sympathomimetic actions. Anticholinergic/ anticholinesterase combinations for neuromuscular block reversal should preferably be omitted, while sugammadex seems more attractive. In regional anaesthesia, addition of epinephrine and high sympathetic blocks should be avoided. Hypotension should be treated with pure alpha-adrenergic agonists. Other pre-excitation abnormalities associated with different accessory pathways are the Mahaim Fiber and Lown-Ganong-Levine syndrome. Sympathetic activation should be avoided. Total intravenous anaesthesia with propofol probably represents the safest option. A careful anaesthetic plan and close cooperation with cardiologists are mandatory for successful management.
PubMed: 30393770
DOI: 10.21454/rjaic.7518.252.stk -
Journal of Cardiovascular... Aug 2022The notion that medically-refractory arrhythmias might one day be amenable to interventional therapy slowly began to appear in the early 1960's. At that time, there were... (Review)
Review
INTRODUCTION
The notion that medically-refractory arrhythmias might one day be amenable to interventional therapy slowly began to appear in the early 1960's. At that time, there were no "interventional electrophysiologists" or "arrhythmia surgeons" and there was little appreciation of the relationship between anatomy and electrophysiology outside the heart's specialized conduction system.
METHODS
In this review, we describe the evolution of collaboration between electrophysiologists and surgeons.
RESULTS
Although accessory atrio-ventricular (AV) connections were first identified in 1893 and the Wolff-Parkinson-White (WPW) syndrome was described 37 years later (1930), it was another 37 years (1967) before those anatomic AV connections were proven to be responsible for the clinical syndrome. The success of the subsequent surgical procedures for the WPW syndrome, AV node reentry tachycardia, automatic atrial tachycardias, ischemic and non-ischemic ventricular tachycardias and atrial fibrillation over the next two decades depended on a close, sometimes daily, collaboration between electrophysiologists and surgeons. In the past two decades, that tight collaboration was largely abandoned until the recent introduction of "hybrid procedures" for the treatment of atrial fibrillation.
CONCLUSIONS
A retrospective assessment of the 50 years of interventional therapy for arrhythmias clearly demonstrates the clinical benefits of a close collaboration between electrophysiologists and arrhythmia surgeons, regardless of which one is actually performing the intervention.
Topics: Atrial Fibrillation; Humans; Retrospective Studies; Surgeons; Tachycardia, Atrioventricular Nodal Reentry; Wolff-Parkinson-White Syndrome
PubMed: 35695795
DOI: 10.1111/jce.15598 -
Clinical Cardiology Aug 2020Accessory pathways are present in 1 in 300 young individuals. They are often asymptomatic and potentially lethal arrhythmias may be the first presentation. During... (Review)
Review
Accessory pathways are present in 1 in 300 young individuals. They are often asymptomatic and potentially lethal arrhythmias may be the first presentation. During long-term follow-up, up to 20% of asymptomatic individuals with pre-excitation go on to develop an arrhythmia and the absence of traditional clinical and electrophysiological high-risk markers does not guarantee the "safe" nature of an accessory pathway. The widespread availability of permanent cure for the condition at low risk by catheter ablation, creates an incentive to screen for accessory pathways with a 12-lead ECG, particularly in individuals who are perceived to be at increased risk, such as athletes and high-risk professions. We review the existing literature on the assessment and management of accessory pathways (Wolff-Parkinson-White [WPW] syndrome) and discuss its implications for the young athletic population.
Topics: Athletes; Catheter Ablation; Electrocardiography; Heart Conduction System; Heart Rate; Humans; Wolff-Parkinson-White Syndrome
PubMed: 32592213
DOI: 10.1002/clc.23399 -
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 -
Kardiologia Polska Mar 2020
Topics: Accessory Atrioventricular Bundle; Arrhythmias, Cardiac; Humans; Prevalence; Risk Factors; Wolff-Parkinson-White Syndrome
PubMed: 32218386
DOI: 10.33963/KP.15248 -
Circulation. Arrhythmia and... Jan 2016
Review
Topics: AMP-Activated Protein Kinases; DNA; Heart Conduction System; Humans; Mutation; Wolff-Parkinson-White Syndrome
PubMed: 26729852
DOI: 10.1161/CIRCEP.115.003121 -
Arquivos Brasileiros de Cardiologia Dec 2022
Topics: Humans; Heart Ventricles; Wolff-Parkinson-White Syndrome; Mutation; AMP-Activated Protein Kinases
PubMed: 36541985
DOI: 10.36660/abc.20220795 -
International Heart Journal Mar 2019A 41-year-old man developed cardiac arrest. A resting 12-lead electrocardiogram showed a delta wave, suggestive of preexcitation syndrome. An electrophysiological test...
A 41-year-old man developed cardiac arrest. A resting 12-lead electrocardiogram showed a delta wave, suggestive of preexcitation syndrome. An electrophysiological test revealed the existence of inducible atrial fibrillation and a fasciculoventricular accessory pathway (FVAP). After these examinations, idiopathic ventricular arrhythmia was suspected. For evaluating concealed Brugada syndrome, pilsicainide was administered, which diminished the delta wave and no Brugada-like electrocardiogram was observed. Ventricular double extra-stimulation from the RV apex easily induced VF, which could not be defibrillated by an external defibrillator, and later stopped spontaneously. These results established the diagnosis of FVAP and idiopathic VF, and not pre-excited atrial fibrillation or Brugada syndrome.
Topics: Accessory Atrioventricular Bundle; Adult; Brugada Syndrome; Death, Sudden, Cardiac; Defibrillators; Diagnosis, Differential; Electric Countershock; Electrocardiography; Electrophysiologic Techniques, Cardiac; Humans; Male; Pre-Excitation Syndromes; Remission, Spontaneous; Treatment Failure; Ventricular Fibrillation
PubMed: 30745545
DOI: 10.1536/ihj.18-546