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Arquivos Brasileiros de Cardiologia Dec 2022Wolff-Parkinson-White (WPW) syndrome is a proarrhythmic condition that may require restriction from strenuous activities and is characterized by ECG signs, including...
BACKGROUND
Wolff-Parkinson-White (WPW) syndrome is a proarrhythmic condition that may require restriction from strenuous activities and is characterized by ECG signs, including delta waves. We observed cases of intermittent WPW patterns presenting as QRS alternans ('WPW alternans') in a large pre-participation ECG screening cohort of young men reporting for military conscription.
OBJECTIVES
We aimed to determine the WPW alternans pattern, case characteristics, and the prevalence of other relevant differential diagnoses presenting as QRS alternans in a pre-participation setting.
METHODS
One hundred twenty-five thousand one hundred fifty-eight prospective male military recruits were reviewed from January 2016 to December 2019. A review of electronic medical records identified cases of WPW alternans and WPW patterns or syndrome. Reviewing electronic medical records identified cases of relevant differential diagnoses that might cause QRS alternans.
RESULTS
Four individuals (2.2%) had WPW alternans out of 184 individuals with a final diagnosis of WPW pattern or syndrome. Two of these individuals manifested symptoms or ECG findings consistent with supraventricular tachycardia. The overall prevalence of WPW alternans was 0.003%, and the prevalence of WPW was 0.147%. WPW alternans represented 8.7% of individuals presenting with QRS alternans, and QRS alternans had a prevalence of 0.037% in the entire population.
CONCLUSIONS
WPW alternans is a variant of intermittent WPW, which comprised 2.2% of WPW cases in our pre-participation screening cohort. It does not necessarily indicate a low risk for supraventricular tachycardia. It must be recognized at ECG screening and distinguished from other pathologies that also present with QRS alternans.
Topics: Humans; Male; Diagnosis, Differential; Electrocardiography; Prospective Studies; Tachycardia, Supraventricular; Wolff-Parkinson-White Syndrome
PubMed: 36417617
DOI: 10.36660/abc.20220081 -
Anatolian Journal of Cardiology Jun 2015Wolff-Parkinson-White (WPW) syndrome presents with paroxysmal supraventricular tachycardia and is characterized by electrocardiographic (ECG) findings of a short PR...
OBJECTIVE
Wolff-Parkinson-White (WPW) syndrome presents with paroxysmal supraventricular tachycardia and is characterized by electrocardiographic (ECG) findings of a short PR interval and a delta wave. The objective of this study was to evaluate the electrophysiological properties of children with WPW syndrome and to develop an algorithm for the management of these patients with limited access to electrophysiological study.
METHODS
A retrospective review of all pediatric patients who underwent electrophysiological evaluation for WPW syndrome was performed.
RESULTS
One hundred nine patients underwent electrophysiological evaluation at a single tertiary center between 1997 and 2011. The median age of the patients was 11 years (0.1-18). Of the 109 patients, 82 presented with tachycardia (median age 11 (0.1-18) years), and 14 presented with syncope (median age 12 (6-16) years); 13 were asymptomatic (median age 10 (2-13) years). Induced AF degenerated to ventricular fibrillation (VF) in 2 patients. Of the 2 patients with VF, 1 was asymptomatic and the other had syncope; the accessory pathway effective refractory period was ≤180 ms in both. An intracardiac electrophysiological study was performed in 92 patients, and ablation was not attempted for risk of atrioventricular block in 8 (8.6%). The success and recurrence rate of ablation were 90.5% and 23.8% respectively.
CONCLUSION
The induction of VF in 2 of 109 patients in our study suggests that the prognosis of WPW in children is not as benign as once thought. All patients with a WPW pattern on the ECG should be assessed electrophysiologically and risk-stratified. Ablation of patients with risk factors can prevent sudden death in this population.
Topics: Adolescent; Catheter Ablation; Child; Child, Preschool; Decision Trees; Electrocardiography; Female; Humans; Infant; Male; Predictive Value of Tests; Retrospective Studies; Risk Assessment; Tachycardia, Supraventricular; Wolff-Parkinson-White Syndrome
PubMed: 26006136
DOI: 10.5152/akd.2014.5462 -
JACC. Clinical Electrophysiology Apr 2018
Topics: Accessory Atrioventricular Bundle; Bundle of His; Catheter Ablation; Child; Follow-Up Studies; Humans; Wolff-Parkinson-White Syndrome
PubMed: 30067484
DOI: 10.1016/j.jacep.2018.02.008 -
Circulation Aug 2008Cardiac memory refers to a change in ventricular repolarization induced by and persisting for minutes to months after cessation of a period of altered ventricular... (Clinical Trial)
Clinical Trial Comparative Study
BACKGROUND
Cardiac memory refers to a change in ventricular repolarization induced by and persisting for minutes to months after cessation of a period of altered ventricular activation (eg, resulting from pacing or preexcitation in patients with Wolff-Parkinson-White syndrome). ECG imaging (ECGI) is a novel imaging modality for noninvasive electroanatomic mapping of epicardial activation and repolarization.
METHODS AND RESULTS
Fourteen pediatric patients with Wolff-Parkinson-White syndrome and no other congenital disease, were imaged with ECGI a day before and 45 minutes, 1 week, and 1 month after successful catheter ablation. ECGI determined that preexcitation sites were consistent with sites of successful ablation in all cases to within a 1-hour arc of each atrioventricular annulus. In the preexcited rhythm, activation-recovery interval (ARI) was the longest (349+/-6 ms) in the area of preexcitation leading to high average base-to-apex ARI dispersion of 95+/-9 ms (normal is approximately 40 ms). The ARI dispersion remained the same 45 minutes after ablation, although the activation sequence was restored to normal. ARI dispersion was still high (79+/-9 ms) 1 week later and returned to normal (45+/-6 ms) 1 month after ablation.
CONCLUSIONS
The study demonstrates that ECGI can noninvasively localize ventricular insertion sites of accessory pathways to guide ablation and evaluate its outcome in pediatric patients with Wolff-Parkinson-White syndrome. Wolff-Parkinson-White is associated with high ARI dispersion in the preexcited rhythm that persists after ablation and gradually returns to normal over a period of 1 month, demonstrating the presence of cardiac memory. The 1-month time course is consistent with transcriptional reprogramming and remodeling of ion channels.
Topics: Action Potentials; Adolescent; Algorithms; Catheter Ablation; Child; Electrocardiography; Female; Heart Atria; Heart Conduction System; Heart Ventricles; Humans; Male; Myocardial Contraction; Predictive Value of Tests; Tomography, X-Ray Computed; Wolff-Parkinson-White Syndrome
PubMed: 18697818
DOI: 10.1161/CIRCULATIONAHA.108.781658 -
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 -
Cardiovascular Journal of AfricaThe first clinical manifestation of the Wolff-Parkinson-White syndrome in previously asymptomatic individuals may be sudden cardiac death. The options for non-invasive...
BACKGROUND
The first clinical manifestation of the Wolff-Parkinson-White syndrome in previously asymptomatic individuals may be sudden cardiac death. The options for non-invasive risk stratification are limited in the current era beyond ambulatory rhythm monitoring and an exercise stress test. In our study, we sought to investigate whether there was a relationship between the shortest measured P- to delta-wave time interval (PDI) on the conduction properties of surface electrocardiogram and accessory pathways expressed as antegrade effective refractory period (APERP).
METHODS
Demographic data, symptom status, electrocardiograms (ECG) and intra-cardiac recordings of invasive electrophysiology testing of 103 patients who underwent accessory pathway ablation procedures were collected. Exclusion criteria were: (1) intermittently occurring pre-excitation, which was detected in previous ECGs, (2) delta-wave resolution on treadmill test, (3) presence of multiple accessory pathways, and (4) accessory pathway locations other than the septum. The PDI was measured as the time interval from the beginning of the P wave to the earliest upstroke or downstroke of the delta wave on V1 and V2 derivations of the surface ECG, and the shortest measurement was recorded.
RESULTS
Patients were grouped into two groups: group I, if APERP was < 240 ms and group II if APERP was ≥ 240 ms. PDI was significantly shorter in group II. By correlation analysis, a positive and moderate correlation between PDI and APERP ( = 0.598, < 0.001) and PDI and age ( = 0.800, < 0.001) was found, and a negative and moderate correlation between PDI and inducible AF ( = -492, < 0.001). The best cut-off value for PDI to predict APERP ≥ 240 was 90.5 ms with a sensitivity of 80% and a specificity of 83%.
CONCLUSIONS
Our results demonstrate that there was a strong correlation between the P- to delta-wave interval and universally accepted risk factors, such as low age, low APERP and atrial fibrillation inducibility. Further studies with larger patient groups and follow-up data are needed to appraise its predictive value.
Topics: Atrial Fibrillation; Death, Sudden, Cardiac; Electrocardiography; Heart Rate; Humans; Wolff-Parkinson-White Syndrome
PubMed: 34128947
DOI: 10.5830/CVJA-2020-057 -
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 the American College of... Jan 2009
Topics: Cause of Death; Child; Disease Progression; Electrocardiography; Female; Follow-Up Studies; Heart Arrest; Humans; Incidental Findings; Male; Risk Assessment; Severity of Illness Index; Tachycardia; Time Factors; Wolff-Parkinson-White Syndrome
PubMed: 19147046
DOI: 10.1016/j.jacc.2008.10.009 -
The Journal of Clinical Investigation Feb 2011Ventricular preexcitation, which characterizes Wolff-Parkinson-White syndrome, is caused by the presence of accessory pathways that can rapidly conduct electrical...
Ventricular preexcitation, which characterizes Wolff-Parkinson-White syndrome, is caused by the presence of accessory pathways that can rapidly conduct electrical impulses from atria to ventricles, without the intrinsic delay characteristic of the atrioventricular (AV) node. Preexcitation is associated with an increased risk of tachyarrhythmia, palpitations, syncope, and sudden death. Although the pathology and electrophysiology of preexcitation syndromes are well characterized, the developmental mechanisms are poorly understood, and few animal models that faithfully recapitulate the human disorder have been described. Here we show that activation of Notch signaling in the developing myocardium of mice can produce fully penetrant accessory pathways and ventricular preexcitation. Conversely, inhibition of Notch signaling in the developing myocardium resulted in a hypoplastic AV node, with specific loss of slow-conducting cells expressing connexin-30.2 (Cx30.2) and a resulting loss of physiologic AV conduction delay. Taken together, our results suggest that Notch regulates the functional maturation of AV canal embryonic myocardium during the development of the specialized conduction system. Our results also show that ventricular preexcitation can arise from inappropriate patterning of the AV canal-derived myocardium.
Topics: Accessory Atrioventricular Bundle; Animals; Atrioventricular Node; Echocardiography; Electrocardiography; Heart Conduction System; Humans; Mice; Receptors, Notch; Signal Transduction; Wolff-Parkinson-White Syndrome
PubMed: 21266778
DOI: 10.1172/JCI44470 -
Indian Pacing and Electrophysiology... 2024To investigate the utility of simultaneous multi-catheter cryotherapy for the treatment of APs that were previously resistant to standard radiofrequency (RF) catheter...
OBJECTIVE
To investigate the utility of simultaneous multi-catheter cryotherapy for the treatment of APs that were previously resistant to standard radiofrequency (RF) catheter ablation.
BACKGROUND
Catheter ablation is established in the treatment of accessory pathways (AP), with high rates of permanent procedural success with a single attempt. However, there are still instances of acute procedural failure and AP recurrences with standard RF and cryotherapy methods.
METHODS
Seven consecutive cases of pre-excitation syndromes with prior failed RF catheter ablation had the novel treatment. Cryotherapy was delivered using two 8 mm tip focal cryoablation catheters (Freezor® Max, Medtronic, Minneapolis, Minnesota, USA).
RESULTS
Accessory pathway localisation was septal in 5 cases, left posterolateral in 1, right lateral in 1. In all cases, ablation of the AP was acutely successful with no procedural complications. Median procedure and fluoroscopy durations were 199 and 35 min, sequentially. Median Procedure duration fell significantly in the second half of series (174 min) compared to the first half (233 min, P = 0.05). One patient had evidence of a recurring AP conduction with pre-excitation at 5-week follow up. After a median follow up of 66.8+-6.5 months, 6 out of 7 patients remained asymptomatic and free of pre-excitation.
CONCLUSION
Simultaneous multi-catheter cryotherapy is feasible, safe and can provide definitive cure of accessory pathways that were previously resistant to standard radiofrequency ablation. Further study is required in the assessment of this novel form of advanced cryotherapy to treat complex and resistant arrhythmias.
PubMed: 37977548
DOI: 10.1016/j.ipej.2023.11.002