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BMC Cardiovascular Disorders May 2020Right free wall accessory pathways (AP) are difficult to treat with catheter ablation as ablation catheter (AC) instability at the tricuspid annulus often precludes...
BACKGROUND
Right free wall accessory pathways (AP) are difficult to treat with catheter ablation as ablation catheter (AC) instability at the tricuspid annulus often precludes successful procedure. The aim of our study was to test a novel intra-cardiac echocardiography (ICE) guided technique for AC placement. Feasibility and success rates were observed.
METHODS
Eight consecutive patients (aged 29 ± 21 years, 4 female) with Wolff-Parkinson-White syndrome and a right free wall AP were included in the study. ICE, three-dimensional (3D) electro-anatomic mapping (EAM) system, and a steerable long sheath were used together with either an irrigated or a non-irrigated tip radio-frequency AC to achieve a "loop" manoeuvre which provided AC tip stability at the ventricular aspect of the tricuspid annulus. X-ray fluoroscopy was not used.
RESULTS
Three patients had an anterior and five had a lateral location of the right free wall AP. Procedures were successful in all patients, without recurrences during the mean follow-up of 397 ± 363 days. Average procedural duration was 90 ± 31 min. On average, 6.6 ± 5.7 ablations were needed. Average time to terminate AP conduction after the start of ablation was 4.8 ± 4.2 s. In five patients (62%) AP conduction was successfully terminated with the first ablation. There were no procedural complications.
CONCLUSIONS
The novel ICE-guided approach with concomitant use of the steerable sheath and the 3D EAM system for zero-fluoroscopy mapping and ablation of the right free wall APs proved feasible and resulted in excellent acute and long-term outcomes.
Topics: Accessory Atrioventricular Bundle; Action Potentials; Adolescent; Adult; Cardiac Catheters; Catheter Ablation; Child; Echocardiography; Feasibility Studies; Female; Heart Rate; Humans; Male; Middle Aged; Operative Time; Retrospective Studies; Time Factors; Treatment Outcome; Ultrasonography, Interventional; Wolff-Parkinson-White Syndrome; Young Adult
PubMed: 32375635
DOI: 10.1186/s12872-020-01494-1 -
Clinical Cardiology Aug 2001
Topics: Aerospace Medicine; Greece; Humans; Incidence; Military Personnel; Prevalence; Risk Factors; United States; Wolff-Parkinson-White Syndrome
PubMed: 11501603
DOI: 10.1002/clc.4960240802 -
Archives of Cardiovascular Diseases Jan 2008Screening for Wolff-Parkinson-White (WPW) syndrome is recommended in children and young adults. The aim of this study was to evaluate the clinical and... (Comparative Study)
Comparative Study
BACKGROUND
Screening for Wolff-Parkinson-White (WPW) syndrome is recommended in children and young adults. The aim of this study was to evaluate the clinical and electrophysiological characteristics of patent WPW syndrome in subjects > or =60 years of age.
METHODS
Four-hundred and fifty-nine consecutive patients with WPW syndrome, aged 8-80 years, were recruited; 32 (7%) of these patients were > or =60 years of age. The clinical, electrophysiological and therapeutic data for these patients were evaluated.
RESULTS
Sixteen men and 16 women, aged 60-81 years (67+/-4.5), were admitted for resuscitated sudden death (1), rapid atrial fibrillation (4), syncope (4), or junctional tachycardia (13); 10 patients were asymptomatic (10). Left lateral bundles of Kent were detected more frequently in patients over 60 years (56%) than in those<60 years of age (40.5%). Reciprocal tachycardia was induced in 58% of subjects<60 years of age and 53% of those > or =60 years old (difference not significant); atrial fibrillation was more frequent in subjects > or =60 years of age (37.5% vs. 19%) (p<0.05). The incidence of malignant forms of WPW syndrome was identical in older and younger subjects. Ablation of the accessory pathway was indicated 18 times; effective ablation of a left bundle of Kent required a second intervention more often in patients > or =60 years of age (22% vs. 5%) (p<0.05).
CONCLUSION
WPW syndrome is not uncommon in subjects over 60 years of age (7%). Left lateral accessory pathways, that have similar conduction properties to those in much younger subjects, are common. Ablation of the bundle of Kent is often difficult but is indicated in symptomatic subjects or those with more serious forms of WPW syndrome.
Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Atrial Fibrillation; Catheter Ablation; Child; Electrocardiography; Electrophysiologic Techniques, Cardiac; Female; Follow-Up Studies; Humans; Male; Middle Aged; Reoperation; Syncope; Tachycardia, Reciprocating; Time Factors; Treatment Outcome; Wolff-Parkinson-White Syndrome
PubMed: 18391868
DOI: 10.1016/s1875-2136(08)70250-x -
British Heart Journal Mar 1975This review discusses the information which can be obtained by cardiac pacing in patients with the Wolff-Parkinson-White syndrome. Programmed electrical stimulation when... (Review)
Review
This review discusses the information which can be obtained by cardiac pacing in patients with the Wolff-Parkinson-White syndrome. Programmed electrical stimulation when combined with the recording of intracardiac electrograms and surface electrocardiograph leads, can be extremely useful in the following areas. 1) Determining the type of the accessory atrioventricular connexions; 2) determining the electrophysiological properties of the accessory atrioventricular pathway; 3) localizing the position of the accessory atrioventricular pathway; 4) determining the mechanisms of any tachycardia; 5) assessing effect of drugs; 6) identifying patients likely to be at high risk; and 7)evaluating postoperative conduction.
Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Electric Stimulation; Electrocardiography; Heart Atria; Heart Conduction System; Heart Ventricles; Humans; Tachycardia; Wolff-Parkinson-White Syndrome
PubMed: 1095036
DOI: 10.1136/hrt.37.3.231 -
Annals of Noninvasive Electrocardiology... Sep 2021The patient is a 19 years-old man who often wakes up in dreams with palpitations and fatigue. The ECG shows: 1. Sinus rhythm; 2. Preexcitation syndrome. Transesophageal...
The patient is a 19 years-old man who often wakes up in dreams with palpitations and fatigue. The ECG shows: 1. Sinus rhythm; 2. Preexcitation syndrome. Transesophageal electrophysiological study (TEEPS) diagnosis:High-risk accessory pathway. During radiofrequency catheter ablation, the patient suddenly developed atrial fibrillation and quickly converted to ventricular fibrillation. After defibrillation, ventricular fibrillation is transformed into sinus rhythm. Subsequently, the patient's high-risk accessory pathway was successfully ablated. Studies have shown that about 25% of patients with WPW syndrome have a refractory period of less than 250 ms, which is one of the risk factors for the conversion of atrial fibrillation to ventricular fibrillation. Therefore, risk stratification is recommended for these symptomatic patients. From 1980 to 1990, there were literature reports on risk stratification of patients with preexcitation syndrome by TEEPS. But it has not become a routine examination of risk stratification in patients with preexcitation syndrome.The reason may be related to the hardware conditions and risk stratification methods used at that time. The TEEPS equipment currently used in our hospital can control the pacing voltage at about 12 mv on average. The voltage in this case report is 9 mv only. In addition, we successfully stratified the risk of patient with preexcitation syndrome without inducing atrial fibrillation. All the electrophysiological records of the patient during the examination were recorded simultaneously with the 12-lead ECG and the esophageal lead ECG. These improvements makes TEEPS a simple, safe and reliable non-invasive cardiac electrophysiological detection technology, which is worth popularizing in hospitals.
Topics: Adult; Catheter Ablation; Electrocardiography; Electrophysiologic Techniques, Cardiac; Humans; Male; Pre-Excitation Syndromes; Risk Assessment; Wolff-Parkinson-White Syndrome; Young Adult
PubMed: 34291526
DOI: 10.1111/anec.12882 -
Journal of the American College of... Jan 2003
Topics: Catheter Ablation; Death, Sudden, Cardiac; Electrophysiologic Techniques, Cardiac; Humans; Practice Guidelines as Topic; Tachycardia, Ventricular; Wolff-Parkinson-White Syndrome
PubMed: 12535817
DOI: 10.1016/s0735-1097(02)02707-9 -
Annals of Noninvasive Electrocardiology... Mar 2018Despite substantial progress in the field of differentiation between ventricular tachycardia (VT) and supraventricular tachycardia (SVT) with wide QRS complexes,...
BACKGROUND
Despite substantial progress in the field of differentiation between ventricular tachycardia (VT) and supraventricular tachycardia (SVT) with wide QRS complexes, differentiation between VT and preexcited SVT remains largely unresolved due to significant overlap in QRS morphology. Our aim was to assess the specificities of various single ECG criteria and sets of criteria (Brugada algorithm, aVR algorithm, Steurer algorithm, and the VT score) for diagnosis of VT in a sizable cohort of patients with preexcitation.
METHODS
We performed a retrospective study of consecutive accessory pathway ablation procedures to identify preexcited tachycardias. Among 670 accessory pathway ablation procedures, 329 cases with good quality ECG with either bona fide preexcited SVT (n = 30) or a surrogate preexcited SVT (fast paced atrial rhythm with full preexcitation, n = 299) were identified. ECGs were analyzed with the use of wide QRS complex algorithms/criteria to determine specificities of these methods.
RESULTS
The Steurer algorithm and VT score (≥3 points), with specificities of 97.6% and 96.1%, respectively, were significantly (p < .01) more specific for the diagnosis of VT than Brugada algorithm, aVR algorithm, and Pava criterion with specificities of 31%, 11.6%, and 57.1%, respectively. The first step of the Brugada algorithm and the first step of the aVR algorithm had also high specificities of 93.3% and 96.0%, respectively.
CONCLUSION
There are sufficient electrocardiographical differences between VT and preexcited SVT to allow electrocardiographic differentiation. VT score, Steurer algorithm, and some single criteria do not overdiagnose VT in patients with preexcitation.
Topics: Aged; Algorithms; Catheter Ablation; Cohort Studies; Diagnosis, Differential; Electrocardiography; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pre-Excitation Syndromes; Retrospective Studies; Tachycardia, Supraventricular; Tachycardia, Ventricular; Treatment Outcome
PubMed: 28901670
DOI: 10.1111/anec.12493 -
Anales de Pediatria Jan 2020
Topics: Diagnosis, Differential; Electric Countershock; Electrocardiography; Female; Humans; Infant; Shock, Cardiogenic; Tachycardia, Ventricular; Wolff-Parkinson-White Syndrome
PubMed: 30956103
DOI: 10.1016/j.anpedi.2019.02.011 -
Europace : European Pacing,... Feb 2024Controversy remains as to whether the exercise stress test (EST) is sufficient for risk evaluation in patients with pre-excitation. This study aims to clarify the...
AIMS
Controversy remains as to whether the exercise stress test (EST) is sufficient for risk evaluation in patients with pre-excitation. This study aims to clarify the usefulness of EST in risk stratification in both asymptomatic and symptomatic patients presenting with pre-excitation.
METHODS AND RESULTS
This prospective study includes consecutive asymptomatic and symptomatic patients with pre-excitation referred for risk assessment. All participants performed an incremental EST (bicycle) prior to an electrophysiology study (EPS). Primary data from the EST included loss of pre-excitation during exercise, and primary data from the EPS included the measurement of accessory pathway effective refractory period (APERP), shortest pre-excited RR interval (SPERRI), and inducible arrhythmia with the use of a beta-adrenergic receptor agonist if deemed necessary. One hundred and sixty-four patients (59 asymptomatic, 105 symptomatic) completed an EST and EPS. Forty-five patients (27%) demonstrated low-risk findings on EST, of which 19 were asymptomatic and 26 were symptomatic. Six patients with low-risk EST findings had SPERRI/APERP ≤ 250 ms at EPS, and two of them were asymptomatic. The sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of low-risk EST for excluding patients with SPERRI/APERP ≤ 250 ms were 40, 91, 87, 51, and 60%, respectively. The number of patients with inducible arrhythmia at EPS was similar in the asymptomatic (36, 69%) and symptomatic (73, 61%) groups.
CONCLUSION
Sudden loss of pre-excitation during EST has a low NPV in excluding high-risk APs. The EPS with the use of isoproterenol should be considered to accurately assess the risk of patients with pre-excitation regardless of symptoms (ClinicalTrials.gov Identifier: NCT03301935).
Topics: Humans; Wolff-Parkinson-White Syndrome; Prospective Studies; Pre-Excitation Syndromes; Accessory Atrioventricular Bundle; Risk Assessment; Electrocardiography
PubMed: 38363996
DOI: 10.1093/europace/euae036 -
British Journal of Anaesthesia Oct 1968
Topics: Adolescent; Anesthesia, General; Atropine; Electrocardiography; Female; Heart Defects, Congenital; Heart Rate; Humans; Pulse; Tachycardia, Paroxysmal; Wolff-Parkinson-White Syndrome
PubMed: 5698536
DOI: 10.1093/bja/40.10.791