Relation Between clinical presentation and induced arrhythmias in the Wolff-Parkinson-White syndrome (original) (raw)
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The American Journal of Cardiology, 1983
Twenty patients with the Wolff-Parkinson-White (WPW) syndrome and 1 or more episodes of symptomatic atrial fibrillation (AF) due to rapid anterograde bypass tract conduction underwent electrophysiologic testing. The mean ventricular rate during spontaneous AF was 242 f 56 beats/min (f standard deviation) and the shortest preexcited R-R interval was 194 f 40 ms. Six patients underwent surgical bypass tract ablation and 14 were treated medically, based on the results of electropharmacologic testing. Over a mean follow-up period of 35 f 19 months (f standard deviation), only 1 patient treated medically had a recurrence of minimally symptomatic AF. The successful chemoprophylaxis of symptomatic AF was associated with the inability to induce AF and atrioventricular reciprocating tachycardia during drug testing (7 patients) or with the induction of AF with a ventricular rate <200 beats/min and a shortest preexcited R-R interval of >250 ms (7 patients). Electrophysiologic testing can identify a subgroup of patients with WPW and AF in whom medical therapy is a suitable alternative to bypass tract ablation. Patients with the Wolff-Parkinson-White syndrome (WPW) who have an episode of atria1 fibrillation (AF) may have an extremely rapid ventricular rate due to rapid conduction through an atrioventricular bypass tract. In addition to causing symptoms due to hemodynamic compromise, such as syncope or weakness, the rapid ventricular rate that occurs during AF may also result in ventricular fibrillation.'p2 One option available for the treatment of patients with WPW who have had an episode of AF associated with an extremely rapid ventricular rate is surgical ablation of the bypass tract." This therapeutic option exposes the patient to the potential risks of open-heart surgery. Few data are available regarding the long-term results of medical therapy in patients with WPW and AF. We therefore examined the role of electrophysiologic testing in selecting patients with WPW and AF who may be appropriate candidates for medical therapy and in designing a drug regimen effective in preventing life-threatening episodes of AF.
Clinical presentation and treatment of atrial fibrillation in Wolff-Parkinson-White syndrome
Heart & Lung: The Journal of Acute and Critical Care, 2010
A case of Wolff-Parkinson-White syndrome with atrial fibrillation (AF) is reported in a patient who presented with syncope, tachycardia, and hypotension. The electrocardiogram (ECG) showed a fast irregular rhythm with wide polymorphic QRS tachycardia without the QRS twisting around the isoelectric baseline, diagnostic of AF and Wolff-Parkinson-White syndrome. The patient did not respond to intravenous amiodarone. Elective cardioversion restored sinus rhythm, and the ECG showed a wide QRS complex, short PR interval, and delta wave, indicating the presence of an accessory pathway and pre-excitation. AF was easily induced during the electrophysiologic study, requiring electrical cardioversion for severe hypotension. Successful radiofrequency ablation of the accessory pathway completely prevented further inducible AF. The patient no longer had any evidence of pre-excitation on ECG and remained symptom-free with no medications for 11 months.
Pacing and Clinical Electrophysiology, 2003
KALARUS, Z., ET AL.: Electrophysiological Features of Orthodromic Atrioventricular Reentry Tachycardia in Patients with Wolff-Parkinson-White Syndrome and Atrial Fibrillation. The aim of this study was to compare the electrophysiological features of tachycardia between WPW patients with and without AF. The study population consisted of 114 patients with WPW syndrome and reciprocating tachycardia during electrophysiological study. Two groups were selected: group I with AF during the procedure (n = 42) and the control group n = 72 without AF (group II). Cycle length (V-V interval), antero A-V, retrograde V-A conduction time during tachycardia and indexes V-A/V-V were analyzed. In addition, the relation between antero-, retrograde conduction time, and V-V was evaluated. Selection of the most predictive factor for AF presence was performed using regression analysis. Significant differences between the two groups were observed. These included a higher rate of tachycardia, shorter anterograde conduction time,
Pace-pacing and Clinical Electrophysiology, 1990
An intracavitary electrophysiological study was carried out on 103 patients with Wolff-Parkinson-Whire (WPW), 23 symptomatic patients had documented episodes of atrial fibrillation, 54 symptomatic patients had atrioventricular reentrant tachycardias, and 26 asymptomatic. Patients were examined for the relation between spontaneous atrial fibrillation and atrial vulnerability, defined as the possibility to induce sustained (> 1 minute) episodes of atrial fibrillation with a stimulation protocol excluding atriai bursts. Atrial fibrillation induction was attempted by single and double atriai extrastimuli during pacing at two different cycle lengths and incremental atrial pacing. Sustained atrial fibrillation was induced in 65% of the patients with spontaneous atrial fibrillation, and in 13% of the symptomatic patients with documented episodes of atrioventricular reentrant tachycardias and in 15% of the asymptomatic patients (P < 0.0005). Atrial vulnerability was higher in patients with spontaneous atrial fibrillation than in patients without this arrhythmia. No significant difference was observed between symptomatic without atrial fibrillation and asymptomatic patients.
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
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.