Aborted sudden death in the Wolff-Parkinson-White syndrome (original) (raw)
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Aborted sudden cardiac death as first presentation of Wolff–Parkinson–White syndrome
Revista Portuguesa de Cardiologia, 2013
Sudden cardiac death (SCD) can be the first clinical manifestation of Wolff-Parkinson-White (WPW) syndrome. Catheter ablation of accessory pathways is now a safe and effective procedure, and is widely recommended in patients with WPW syndrome. However, management of the asymptomatic WPW patient remains controversial. Recent studies have readdressed the issue of risk stratification and prophylactic catheter ablation. We describe a case of malignant arrhythmia and aborted SCD as first presentation of WPW syndrome in a previously asymptomatic 17-year-old patient.
Relation Between clinical presentation and induced arrhythmias in the Wolff-Parkinson-White syndrome
American Journal of Cardiology, 1987
Electrophysiologic testing is warranted in patients with the Wolff-Parkinson-White (WPW) syndrome presenting with rapid atrial fibrillation (AF) or ventricular fibrillation. Indications are less clear in patients presenting only with atrioventricular reentrant tachycardia (ART). A knowledge of propensity of this latter group to show a rapid ventricular response in the event of AF and the ability of electrophysiologic testing to reproduce the type and rate of clinical arrhythmias are relevant to this decision. The records of 126 symptomatic patients with manifest WPW syndrome were reviewed and separated into 4 groups according to presentation: group l-AF; group P-ART; group 3-palpitations suggesting ART; and group 4-AF and ART. All patients except those in group 3 had electrocardiographically documented clinical arrhythmias, and these arrhythmias were compared with those induced during electrophysiologic testing. The shortest RR interval during induced AF and the cycle length of induced ART correlated well with those occurring clinically (r = 0.72, p <O.OOOOl), as did the cycle length of induced ART (r = 0.79, p <O.OOOOl). Patients presenting with AF (65% ) had a higher incidence of atrial vulnerability (46%) and sustained AF at electrophysiologic testing than those presenting with ART (16 % and 5 % ) or undocumented palpitations (27 % and 21% ). Forty-one percent of patients with ART and 51% with undocumented palpitations had potentially lethal rates (shortest RR interval <250 ms) during induced AF. The ability to reproduce clinical arrhythmias and the frequency of rapid rates during AF induced in patients presenting with only ART or undocumented palpitations supports the recommendation for electrophysiologic testing in symptomatic patients with WPW. (Am J Cardiol 1967;60:576-579) T here is general agreement that therapy guided by electrophysiologic testing is indicated in patients with Wolff-Parkinson-White (WPW] syndrome who present with atria1 fibrillation (AF] and a rapid ventricular response over the accessory pathway.1 It is less clear whether electrophysiologic testing is necessary in patients with anterograde preexcitation presenting with well tolerated atrioventricular reentrant tachycardia (ART] or undocumented palpitations suggestive of ART. Knowledge of the propensity of the latter groups to have a rapid ventricular response to AF may be helpful in addressing this issue. We compared the electrophysiologic properties of the accessory pathway in patients presenting with ART or with undocument-
The Asymptomatic Patient with the Wolff-Parkinson-White Electrocardiogram
Pace-pacing and Clinical Electrophysiology, 1997
Sudden death can be the first manifestation of the Wolff-Parkinson-White (WPW) syndrome. The underlying mechanism being atrial fibrillation with a very high ventricular rate, because of a short anterograde refractory period of the accessory atrioventricular pathway (AP), deteriorating into ventricular fibrillation. Information on the anterograde refractory period of the AP is therefore important to recognize asymptomatic people with the WPW ECG at risk for dying suddenly. Several noninvasive tests are available to identify the low risk patient. Decision making when to interrupt the AP in asymptomatic WPW patients not at low risk requires an invasive study to document the electrophysiological properties of the AP and to determine its exact location.
Atrial and Ventricular Vulnerability in a Patient with the Wolff-Parkinson-White Syndrome
Pacing and Clinical Electrophysiology, 1981
vulnerability in a palient with the Woljj-Parkinson-W'hile syndrome. An electrophysjoiogic study was carried out in a patient with the Woljj-Parkinson-White syndrome and a history of sponfuneous atrial fibrillafion but with no evidence oj organic cardiac disease. A singJe induced premature ventricular depoiarizalion resulted in ventricular tachycardia joUowed by ventricular fibrillation. Similarly, airial pacing or premature atrial siimulation resulted in frequent episodes of airial fibrillation or flutter. The atrial and ventricular effective refractory periods were 180 ms and < 160 ms. respectively, al a driven cycle length of 480 ms. Intravenous adminislralion of procainamide resulted in lengthening of the refractory periods and failure to induce either atriai or venlricular arrhythmias with pacing. In most patients with enhanced atrioventricular nodal or accessory atrioventricular nodal bypass, Ihe mechanism of ventricular tachycardia is related to an inordinately rapid ventricular response during supraventricular arrhythmias. In our patient, a unique mechonism was apparent; atrial and venlricular vulnerability to fibrillation was associated with extremely short myocardial effective refraclory periods. The relationship of this finding to sudden cardiac death bears further study. (PACE. Vol. 4, January-February, 1981} atrial vulnerability, ventricular vulnerability, Wolff-ParJiinson-White syndrome. ventricular fibrillation, atrial fibrillation, atrial flutter Atrial fibrillation is a well-documenled complication in palients with the Wolff-Parkinson-White syndrome and its occurrence has been related to increased citrial vulnerability during reciprocating atrioventricular tachycardia or to delayed atrial conduction.'"^ Less clear, however, is the relationship between ventricular arrhythmias and preexcitation. This uncer
Myocardial infarction in an individual with Wolff-Parkinson-White syndrome
Romanian Journal of Legal Medicine, 2013
A case of recent myocardial infarction in a 24-year-old man with no known history of Wolff-Parkinson-White syndrome is reported. The patient developed during sport training an exercise tachycardia associated with palpitation and syncope. The electrocardiogram, performed by rescue team, was suggestive of Wolff-Parkinson-White syndrome. He was admitted to Cardiovascular Diseases Institute for this first attack of rapid heart beating which did not readily subside. He died suddenly after admission, with no response to resuscitation maneuvers and before other investigations were performed. Autopsy examination of the heart revealed no accessory atrioventricular connection, but revealed a recent myocardial infarction. The case underlines the potential danger of the Wolff-Parkinson-White syndrome in patients with no or minimal clinical manifestations. The rapid unexpected death can be attributed to atrial fibrillation with rapid ventricular response via the anomalous connection. A meticulous histological study of the atrioventricular function in hearts of young athletes with unexplained death is a necessity.
Europace, 2005
The mechanism by which atrial fibrillation is initiated in patients with accessory pathways is not fully understood. Retrograde conduction of ventricular premature beats to the atrium, causing the arrhythmia, is a very rare cause. We report a patient with WolffeParkinsoneWhite syndrome (WPW), without previous tachycardias, who presented multiple episodes of paroxysmal atrial fibrillation after having a myocardial infarction. During the electrophysiological (EP) study the patient presented two spontaneous episodes of atrial fibrillation initiated by ventricular premature beats conducted to the atria through the accessory pathway. After successful catheter ablation of the accessory pathway the patient did not present arrhythmia recurrences.
American Journal of Cardiology, 1989
Noninvasive stress and pharmacologic tests with procainamide and propafenone were studii as methods to identify patients with Wolff-Parkinson-White syndrome (WPW) who would otherwise be judged at risk of sudden death on the basis of electrophysiologlc criteria: the shortest RR interval during induced atrial fibrillation I2!JO ms or accessory pathway anterograde effective refractery period 250 ms. sixty-five patients were studied. Twenty-four patients fulftlled the electrophysiologii risk criteria (group A) and 41 patients fuffilled none of these criteria (group B). Persistence of preexcitation during stress test showed a sensltivity of 96% and a specificity of 17% to identlfy group A patientq its posJtive predictive value was 40% and negative predktive value 33%. with both procainamide and propafenone tests persistence of preexcitation Identified group A patients with a sensitlvlty of 36% and a speclflcity of 51%; their positive and negative predictive value were, respectively, 53 and 95%. Stress and pharmacologic tests have good sensltlvRy and negative predictive value, but low speclflcity and positive predictive value.