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de Alencar Neto JN, Sakai MH, de Almeida Neto RG, Scheffer MK, Alencar E Silva GPS, Cirenza C, de Paola AAV. EPM algorithm: A stepwise approach to accessory pathway localization in ventricular pre-excitation. J Electrocardiol 2024; 84:1-8. [PMID: 38430664 DOI: 10.1016/j.jelectrocard.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/05/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Accurate estimation of accessory pathway (AP) localization in patients with ventricular pre-excitation or Wolff-Parkinson-White (WPW) syndrome remains a diagnostic challenge. Existing algorithms have contributed significantly to this area, but alternative algorithms can offer additional perspectives and approaches to AP localization. OBJECTIVE This study introduces and evaluates the diagnostic accuracy of the EPM algorithm in AP localization, comparing it with established algorithms Arruda and EASY. METHODS A retrospective analysis was conducted on 138 patients from Hospital São Paulo who underwent catheter ablation. Three blinded examiners assessed the EPM algorithm's diagnostic accuracy against the Arruda and EASY algorithms. The gold standard for comparison was the radioscopic position of the AP where radiofrequency ablation led to pre-excitation disappearance on the ECG. RESULTS EPM showed a diagnostic accuracy of 51.45%, closely aligning with Arruda (53.29%) and EASY (44.69%). Adjacency accuracy for EPM was 70.67%, with Arruda at 66.18% and EASY at 72.22%. Sensitivity for EPM in distinguishing left vs. right APs was 95.73%, with a specificity of 74.33%. For identifying septal vs. lateral right APs, EPM sensitivity was 82.79% with a specificity of 46.15%. These measures were comparable to those of Arruda and EASY. Inter-observer variability was excellent for EPM, with Kappa statistics over 0.9. CONCLUSION The EPM algorithm emerges as a reliable tool for AP localization, offering a systematic approach beneficial for therapeutic decision-making in electrophysiology. Its comparable diagnostic accuracy and excellent inter-observer variability underscore its potential clinical applicability. Future research may further validate its efficacy in a broader clinical setting.
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Affiliation(s)
- José Nunes de Alencar Neto
- Tele-Electrocardiography Division, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil; Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital São Paulo, São Paulo, Brazil.
| | - Marcel Henrique Sakai
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital São Paulo, São Paulo, Brazil
| | | | - Matheus Kiszka Scheffer
- Tele-Electrocardiography Division, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | | | - Claudio Cirenza
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital São Paulo, São Paulo, Brazil
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Iyengar SK, Elzamar M, Ko Ko NL, Srivathsan K. An unusual property of the fasciculoventricular pathway with conduction block. HeartRhythm Case Rep 2024; 10:29-32. [PMID: 38264097 PMCID: PMC10800996 DOI: 10.1016/j.hrcr.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Affiliation(s)
| | - Mohamed Elzamar
- Division of Cardiovascular Diseases, Mayo Clinic Hospital, Phoenix, Arizona
| | - Nway L. Ko Ko
- Division of Cardiovascular Diseases, Mayo Clinic Hospital, Phoenix, Arizona
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Hessling G, Telishevska M, Lengauer S, Deisenhofer I. ["Asymptomatic WPW" : Is treatment necessary?]. Herzschrittmacherther Elektrophysiol 2023; 34:114-121. [PMID: 36939928 DOI: 10.1007/s00399-023-00930-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/30/2023] [Indexed: 03/21/2023]
Abstract
The term "asymptomatic WPW" (Wolff-Parkinson-White) is often used as a synonym for ventricular pre-excitation of the WPW type due to an accessory pathway characterized by a short PR interval and a delta wave on the electrocardiogram (ECG) without the clinical occurrence of paroxysmal tachycardia. Asymptomatic WPW is often diagnosed in young and otherwise healthy people. There is a small associated risk of sudden cardiac death due to rapid antegrade conduction over the accessory pathway during atrial fibrillation. This paper highlights aspects of noninvasive and invasive risk stratification, therapy by catheter ablation, and the ongoing risk-benefit discussion in asymptomatic WPW.
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Affiliation(s)
- Gabriele Hessling
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, Lazarettstr. 36, 80636, München, Deutschland.
| | - Marta Telishevska
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, Lazarettstr. 36, 80636, München, Deutschland
| | - Sarah Lengauer
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, Lazarettstr. 36, 80636, München, Deutschland
| | - Isabel Deisenhofer
- Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, Klinik an der Technischen Universität München, Lazarettstr. 36, 80636, München, Deutschland
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Vari D, Kurek N, Zang H, Anderson JB, Spar DS, Czosek RJ. Outcomes in Infants with Supraventricular Tachycardia: Risk Factors for Readmission, Recurrence and Ablation. Pediatr Cardiol 2022:10.1007/s00246-022-03035-3. [PMID: 36271968 DOI: 10.1007/s00246-022-03035-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/14/2022] [Indexed: 11/26/2022]
Abstract
Supraventricular tachycardia (SVT) is the most common arrhythmia in infants. Once diagnosed, infants are admitted for antiarrhythmic therapy and discharged after observation. There are limited data on risk factors for readmission and readmission rates, while on medication. The objective of this study was to investigate risk factors for readmission and outcomes in infants diagnosed with SVT. This is a single-center retrospective study over a 10-year period of infants under 6 months of age with documented SVT. Infants with congenital heart disease requiring surgical or catheter intervention, gestational age less than 32 weeks or diagnosis of atrial flutter or fibrillation were excluded. The primary outcome was readmission within 31 days of hospital discharge. Long term need for ablation and eventual discontinuation of medications were assessed. Ninety patients were included. Beta blockers were the initial therapy in 66 and 28 required a medication change. Nineteen were readmitted within 31 days of discharge. The only clinical factor associated with early readmission was presence of ventricular pre-excitation (6/19 vs. 8/71, p = 0.03). Patients who were readmitted within 31 days had a longer length of treatment (12 [11.5, 22.0] vs. 10 [7.5, 12.0] months, p = 0.007) and were more likely to undergo ablation (4/19 vs. 2/71, p = 0.017). In this cohort of infants with SVT, readmission was common and ventricular pre-excitation was identified as a risk factor for readmission. Infants who were readmitted within 31 days of discharge had longer length of antiarrhythmic therapy and were more likely to undergo catheter ablation.
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Affiliation(s)
- Daniel Vari
- Cincinnati Children's Hospital Medical Center, The Heart Institute, Cincinnati, OH, 45229, USA.
| | - Nicholas Kurek
- Division of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
| | - Huaiyu Zang
- Cincinnati Children's Hospital Medical Center, The Heart Institute, Cincinnati, OH, 45229, USA
| | - Jeffrey B Anderson
- Cincinnati Children's Hospital Medical Center, The Heart Institute, Cincinnati, OH, 45229, USA
| | - David S Spar
- Cincinnati Children's Hospital Medical Center, The Heart Institute, Cincinnati, OH, 45229, USA
| | - Richard J Czosek
- Cincinnati Children's Hospital Medical Center, The Heart Institute, Cincinnati, OH, 45229, USA
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Zhang Y, Li XM, Cui J, Jiang H, Li JH, Li MT. Analysis of the influencing factors associated with dyssynchrony and cardiac dysfunction in children with ventricular pre-excitation. Cardiol Young 2022;:1-9. [PMID: 35707913 DOI: 10.1017/S104795112200172X] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the correlation between ventricular pre-excitation-related dyssynchrony, on cardiac dysfunction, and recovery. METHODS AND RESULTS This study included 76 children (39 boys and 37 girls) with a median age of 5.25 (2.67-10.75) years. The patients with pre-excitation-related cardiac dysfunction (cardiac dysfunction group, n = 34) had a longer standard deviation of the time-to-peak systolic strain of the left ventricle and larger difference between the maximum and minimum times-to-peak systolic strain than those with a normal cardiac function (normal function group, n = 42) (51.77 ± 24.70 ms versus 33.29 ± 9.48 ms, p < 0.05; 185.82 ± 92.51 ms versus 111.93 ± 34.27 ms, p < 0.05, respectively). The cardiac dysfunction group had a maximum time-to-peak systolic strain at the basal segments of the anterior and posterior septa and the normal function group at the basal segments of anterolateral and posterolateral walls. The prevalence of ventricular septal dyssynchrony in the cardiac dysfunction group was significantly higher than that in the normal function group (94.1% (32/34) versus 7.7% (3/42), p < 0.05). The patients with ventricular septal dyssynchrony (n = 35) had a significantly higher prevalence of intra-left ventricular systolic dyssynchrony than those with ventricular septal synchrony (n = 41) (57.1% (20/35) versus 14.6% (6/41), p < 0.05). During follow-up after pathway ablation, the patients who recovered from intra-left ventricular dyssynchrony (n = 29) had a shorter left ventricular ejection fraction recovery time than those who did not (n = 5) (χ2 = 5.94, p < 0.05). Among the patients who recovered, 93.1% (27/29) had a normalised standard deviation of the time-to-peak systolic strain and difference between the maximum and minimum times-to-peak systolic strain within 1 month after ablation. CONCLUSION Ventricular pre-excitation may cause ventricular septal dyssynchrony; thus, attention must be paid to intra-left ventricular dyssynchrony and cardiac dysfunction. Whether intra-left ventricular systolic dyssynchrony can resolve within 1 month may be a new early predictor of patient prognosis.
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Anderson RH, Sanchez-Quintana D, Mori S, Spicer DE, Wellens HJJ, Lokhwandala Y, Cabrera JA, Farre J, Sternick EB. Miniseries 2-septal and paraseptal accessory pathways-Part I: The anatomic basis for the understanding of para-Hisian accessory atrioventricular pathways. Europace 2022; 24:639-649. [PMID: 34999776 DOI: 10.1093/europace/euab292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/08/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS Although the anatomy of the atrioventricular conduction axis was well described over a century ago, the precise arrangement in the regions surrounding its transition from the atrioventricular node to the so-called bundle of His remain uncertain. We aimed to clarify these relationships. METHODS AND RESULTS We have used our various datasets to examine the development and anatomical arrangement of the atrioventricular conduction axis, paying particular attention to the regions surrounding the point of penetration of the bundle of His. It is the areas directly adjacent to the transition of the atrioventricular conduction axis from the atrioventricular node to the non-branching atrioventricular bundle that constitute the para-Hisian areas. The atrioventricular conduction axis itself traverses the membranous part of the ventricular septum as it extends from the node to become the bundle, but the para-Hisian areas themselves are paraseptal. This is because they incorporate the fibrofatty tissues of the inferior pyramidal space and the superior atrioventricular groove. In this initial overarching review, we summarize the developmental and anatomical features of these areas along with the location and landmarks of the atrioventricular conduction axis. We emphasize the relationships between the inferior pyramidal space and the infero-septal recess of the subaortic outflow tract. The details are then explored in greater detail in the additional reviews provided within our miniseries. CONCLUSION Our anatomical findings, described here, provide the basis for our concomitant clinical review of the so-called para-Hisian arrhythmias. The findings also provide the basis for understanding the other variants of ventricular pre-excitation.
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Affiliation(s)
- Robert H Anderson
- Institute of Biosciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Diane E Spicer
- Department of Pediatric Cardiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Hein J J Wellens
- CARIM- Cardiovascular Research Centre, Maastricht, Maastricht, The Netherlands
| | | | - Jose-Angel Cabrera
- Unidad de Arritmias, Departamento de Cardiología, Hospital Universitario Quirón-Salud, Madrid and Complejo Hospitalario Ruber Juan Bravo, Universidad Europea de Madrid, Spain
| | - Jeronimo Farre
- Cardiology Department, Arrhythmia Unit, Institute of Health Sciences Investigations of Jiménez Díaz Foundation, and Madrid Autonomous University, Madrid, Spain
| | - Eduardo Back Sternick
- Arrhythmia and Electrophysiology Unit, Biocor Instituto, Nova Lima, Minas Gerais, Brazil
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Macías Y, Tretter JT, Anderson RH, Sánchez-Quintana D, Soares Correa F, Farré J, Back Sternick E. Miniseries 1-Part IV: How frequent are fasciculo-ventricular connections in the normal heart? Europace 2022; 24:464-472. [PMID: 34999781 DOI: 10.1093/europace/euab286] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Seeking to account for accessory atrioventricular conduction potentially leading to ventricular pre-excitation, Mahaim in the mid-20th century had described pathways between the atrioventricular conduction axis and the muscular ventricular septum. We aimed to look for such 'paraspecific' connections in adult human hearts. METHODS AND RESULTS We serially sectioned 21 hearts, covering the triangle of Koch and the aortic root, and assessing the atrioventricular node, the penetration of the conduction axis, and the bundle branches in our search for fasciculo-ventricular connections. We also calculated the length of the non-branching bundle, and if present the origin of the fasciculo-ventricular connections. The non-branching bundle was 3.6 ± 1.7 mmin length, varying from 1.7 mm to 7.2 mm. Fasciculo-ventricular connections were found in more than half of the hearts, making direct contact with the muscular septum at an average of 3.5 ± 1.7 mm from the origin of the left bundle branch, with the site of origin varying from 1.1 mm to 5.5 mm from the first fascicle of the left bundle branch. In three hearts, additional fasciculo-fascicular connections were observed in the left bundle branch. Two loops were small, but one loop extended over 9.5 mm. CONCLUSION We endorse the finding of Mahaim that fasciculo-ventricular pathways exist in most human hearts. We presume the identified connections had the capability of producing ventricular pre-excitation. More studies are needed to determine the potential clinical manifestations.
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Affiliation(s)
- Yolanda Macías
- Faculty of Medicine, Department of Human Anatomy and Cell Biology, University of Extremadura, Badajoz, Spain
| | - Justin T Tretter
- Department of Pediatrics, Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Robert H Anderson
- Biosciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Damián Sánchez-Quintana
- Faculty of Medicine, Department of Human Anatomy and Cell Biology, University of Extremadura, Badajoz, Spain
| | - Frederico Soares Correa
- Department of Arrhythmia and Electrophysiology, Biocor Instituto, Nova Lima, Minas Gerais, Brazil
| | - Jerónimo Farré
- Fundación Jiménez Díaz University Hospital and Institute of Biomedical Research, Madrid, Spain
| | - Eduardo Back Sternick
- Department of Medical and Surgical Therapeutics, Veterinary Faculty, University of Extremadura, Cáceres, Spain
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Zhang Y, Li XM. Pre-excitation cardiac problems in children: recognition and treatment. Eur J Pediatr 2020; 179:1197-204. [PMID: 32529398 DOI: 10.1007/s00431-020-03701-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
The prevalence of ventricular pre-excitation is 0.07-0.2% in the pediatric population. Kent bundle is the most common atrioventricular accessory pathway and Mahaim fiber is relatively rare. Approximately, 30-60% of children with ventricular pre-excitation have onset of atrioventricular reentrant tachycardia. Persistent atrioventricular reentrant tachycardia can lead to tachycardiomyopathy. The anterograde conduction of right accessory pathway might lead to ventricular systolic dyssynchrony which might result in cardiac dysfunction even in patients with no tachycardia onset. This type of dilated cardiomyopathy was named as accessory pathway-induced dilated cardiomyopathy. Antiarrhythmic drugs can be used to acutely terminate tachycardia or taken orally to decrease tachycardia recurrence in the long term. However, antiarrhythmic drugs that can be chosen for children are quite limited. Sotalol has become a new choice. With the maturation of radiofrequency catheter ablation technique, progress in three-dimensional electro-anatomic mapping, use of cryoablation, and accumulation of experience in children with small age and weight, catheter ablation has become the first choice for children with pre-excitation syndrome.Conclusion: For ventricular pre-excitation co-exists with dilated cardiomyopathy, differential diagnosis of tachycardiomyopathy or accessory pathway-induced dilated cardiomyopathy should be considered. Catheter ablation (radiofrequency and cryoablation) is a relatively safe and effective treatment option and has become the first choice to treat children with ventricular pre-excitation. What is Known: • Persistent atrioventricular reentrant tachycardia in children can lead to tachycardiomyopathy; • Antiarrhythmic drugs that can be chosen for children are quite limited. What is New: • The anterograde conduction of right accessory pathway (not related to supraventricular tachycardia) might lead to accessory pathway-induced dilated cardiomyopathy. • Catheter ablation (including radiofrequency and cryoablation) has become the first choice for children with pre-excitation syndrome.
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Khaznadar R, Chandler SF, Chaouki AS, Tsao S, Webster G. Non-invasive Risk Stratification in Pediatric Ventricular Pre-excitation. Pediatr Cardiol 2020; 41:709-715. [PMID: 31974716 PMCID: PMC7261251 DOI: 10.1007/s00246-020-02285-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
Children with ventricular pre-excitation are at risk for sudden death. This retrospective pediatric study identified patients > 8 years of age who had undergone electrophysiology study (EPS). Our primary objective was to determine the performance characteristics of non-invasive risk stratification. Subjects were separated into two groups. Group 1 was asymptomatic or had non-specific symptoms (palpitations, chest pain, and light headedness) without documented supraventricular tachycardia (SVT). Group 2 had syncope, documented SVT, or a life-threatening event. As a secondary aim, we tested whether patients with severe symptoms had a shorter time from the date of diagnosis to the date of invasive risk stratification. Among 93 patients with an average age of 14.2 years, 25 patients had documented SVT, 6 had syncope, and 1 had a life-threatening event. The sensitivity of non-invasive risk stratification was 7%. The specificity was 91%. The positive predictive valve was 14% and the negative predictive value was 84%. Even patients with severe symptoms commonly underwent non-invasive risk stratification prior to EPS, albeit at a lower rate (Group 1, 98%; Group 2 84%, p = 0.02). The median time to EPS was 4.2 months (Group 1) and 4.5 months (Group 2, p = 0.63). Non-invasive risk stratification was a poor predictor of invasive risk stratification. Cardiologists should counsel families about the limitations of non-invasive risk stratification and consider starting with invasive risk stratification and possible ablation. Counterintuitively, severe symptoms were not associated with a shorter time to electrophysiology study.
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Affiliation(s)
| | | | | | | | - Gregory Webster
- Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 21, Chicago, IL, 60611, USA.
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Guo B, Dai C, Li Q, Li W, Han L. Hazards of ventricular pre-excitation to left ventricular systolic function and ventricular wall motion in children: analysis of 25 cases. Cardiol Young 2019; 29:380-8. [PMID: 30767835 DOI: 10.1017/S1047951118002500] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AimThe aim was to attach importance to the hazards of ventricular pre-excitation on left ventricular systolic function and size. METHOD: We analysed the clinical, electrophysiological, and echocardiographic characteristics of the 25 cases with abnormal ventricular wall motion, left ventricular systolic dysfunction, or dilation with co-existing right-sided overt accessary pathways before and after ablation or medication during March 2011 and June 2017. Moreover, we compared the therapy effect between patients with ventricular pre-excitation-induced dilated cardiomyopathy and idiopathic dilated cardiomyopathy without ventricular pre-excitation.ResultAbnormal ventricular wall motion was demonstrated using M-mode echocardiography in 23 cases. The basal segments of the interventricular septum became thin and moved similarly to an aneurysm with typical bulging during end-systole, which was observed in 16 cases. Dilated cardiomyopathy was diagnosed in 14 cases. A total of 23 patients underwent successful ablations and received medications, and the other two patients received only oral medications because of young age. The prognosis of pre-excitation-induced dilated cardiomyopathy is better than idiopathic dilated cardiomyopathy. All the cases with abnormal ventricular wall motion demonstrated recovery of normal left ventricular ejection fraction and decreased left ventricular end-diastolic diameter through ablation. CONCLUSION: Ventricular pre-excitation caused by right-sided accessory pathways may result in abnormal ventricular wall motion, left ventricular systolic dysfunction, dilation, and even dilated cardiomyopathy. In some cases with dilated cardiomyopathy, ventricular pre-excitation may not be the cause of disease but a harmful factor which hampered the recovering of left ventricular systolic function. These conditions are indications for ablation with good prognosis.
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Thevenon J, Laurent G, Ader F, Laforêt P, Klug D, Duva Pentiah A, Gouya L, Maurage CA, Kacet S, Eicher JC, Albuisson J, Desnos M, Bieth E, Duboc D, Martin L, Réant P, Picard F, Bonithon-Kopp C, Gautier E, Binquet C, Thauvin-Robinet C, Faivre L, Bouvagnet P, Charron P, Richard P. High prevalence of arrhythmic and myocardial complications in patients with cardiac glycogenosis due to PRKAG2 mutations. Europace 2017; 19:651-659. [PMID: 28431061 DOI: 10.1093/europace/euw067] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 02/23/2016] [Indexed: 12/20/2022] Open
Abstract
AIMS Mutations in PRKAG2, the gene encoding for the γ2 subunit of 5'-AMP-activated protein kinase (AMPK), are responsible for an autosomal dominant glycogenosis with a cardiac presentation, associating hypertrophic cardiomyopathy (HCM), ventricular pre-excitation (VPE), and progressive heart block. The aim of this study was to perform a retrospective time-to-event study of the clinical manifestations associated with PRKAG2 mutations. METHODS AND RESULTS A cohort of 34 patients from 9 families was recruited between 2001 and 2010. DNA were sequenced on all exons and flanking sequences of the PRKAG2 gene using Sanger sequencing. Overall, four families carried the recurrent p.Arg302Gln mutation, and the five others carried private mutations among which three had never been reported. In the total cohort, at 40 years of age, the risk of developing HCM was 61%, VPE 70%, conduction block 22%, and sudden cardiac death (SCD) 20%. The global survival at 60 years of age was 66%. Thirty-two per cent of patients (N = 10) required a device implantation (5 pacemakers and 5 defibrillators) at a median age of 66 years, and two patients required heart transplant. Only one patient presented with significant skeletal muscle symptoms. No significant differences regarding the occurrence of VPE, ablation complications, or death incidence were observed between different mutations. CONCLUSION This study of patients with PRKAG2 mutations provides a more comprehensive view of the natural history of this disease and demonstrates a high risk of cardiac complications. Early recognition of this disease appears important to allow an appropriate management.
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Affiliation(s)
- Julien Thevenon
- Centre de Génétique et Centre de Référence "Anomalies du Développement et Syndromes Malformatifs", Hôpital d'Enfants, CHU Dijon, Dijon, France
| | - Gabriel Laurent
- Service de Rythmologie et Insuffisance Cardiaque, Hôpital du Bocage, Centre Hospitalo-Universitaire de Dijon, Dijon, France
- Laboratoire LE2I UMR CNRS 5158, Université de Bourgogne, 9 avenue Alain Savary, Dijon, France
| | - Flavie Ader
- AP-HP, UF Cardiogénétique et Myogénétique, Service de Biochimie Métabolique, Groupe Hospitalier Pitié-Salpêtrière 47-83 boulevard de l'Hôpital, Paris cedex 13 75651, France
| | - Pascal Laforêt
- AP-HP, Centre de Référence de pathologie neuromusculaire Paris-Est, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Didier Klug
- Hôpital Cardiologique, Bd du Pr Leclercq 59037, Lille, France
| | | | - Laurent Gouya
- INSERM U773, Centre de Recherche Biomédicale Bichat Beaujon CRB3, Université Paris 7 Denis Diderot, site Bichat, Paris, France
| | - Claude Alain Maurage
- Université Lille Nord de France, USDL, EA 1056, Lille F-59000, France
- Département de Pathologie, Hôpital Universitaire de Lille, Lille F-59000, France
- INSERM U837, Lille F-59000, France
| | - Salem Kacet
- Hôpital Cardiologique, Bd du Pr Leclercq 59037, Lille, France
| | - Jean-Christophe Eicher
- Service de Rythmologie et Insuffisance Cardiaque, Hôpital du Bocage, Centre Hospitalo-Universitaire de Dijon, Dijon, France
| | - Juliette Albuisson
- INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France
- AP-HP, Département de génétique, Hôpital européen Georges-Pompidou, 20, rue Leblanc, Paris 75015, France
- Inserm U 633, faculté de médecine, université Paris-5, Paris 75015, France
| | - Michel Desnos
- INSERM, UMRS_970, Paris Cardiovascular Research Center, Paris, France
- AP-HP, Département de génétique, Hôpital européen Georges-Pompidou, 20, rue Leblanc, Paris 75015, France
- Inserm U 633, faculté de médecine, université Paris-5, Paris 75015, France
| | - Eric Bieth
- Department of Medical Genetics, Hôpital Purpan, Toulouse, France
| | - Denis Duboc
- AP-HP, Service de Cardiologie, Hôpital Cochin, Paris, France
| | - Laurent Martin
- Laboratoire d'anatomopathologie, Plateau technique de Biologie, CHU de Dijon, Dijon, France
| | - Patricia Réant
- Service de Cardiologie, Hôpital Haut-Lévèque, Pessac, France
| | - François Picard
- Service de Cardiologie, Hôpital Haut-Lévèque, Pessac, France
| | - Claire Bonithon-Kopp
- Centre d'investigation clinique-épidémiologie clinique/essais cliniques, CHU, Dijon, France
| | - Elodie Gautier
- Centre d'investigation clinique-épidémiologie clinique/essais cliniques, CHU, Dijon, France
| | - Christine Binquet
- Centre d'investigation clinique-épidémiologie clinique/essais cliniques, CHU, Dijon, France
| | - Christel Thauvin-Robinet
- Centre de Génétique et Centre de Référence "Anomalies du Développement et Syndromes Malformatifs", Hôpital d'Enfants, CHU Dijon, Dijon, France
| | - Laurence Faivre
- Centre de Génétique et Centre de Référence "Anomalies du Développement et Syndromes Malformatifs", Hôpital d'Enfants, CHU Dijon, Dijon, France
| | - Patrice Bouvagnet
- Service médico-chirurgical Cardiologie Pédiatrique et Congénitale Adulte, Laboratoire Cardiogénétique, CHU de Lyon HCL-GH Est-Hôpital Louis Pradel, 69677 BRON CEDEX, et EA4173 Université Lyon 1 et Hôpital du Nord-Ouest, Lyon, France
| | - Philippe Charron
- AP-HP, Centre de référence des maladies cardiaques héréditaires, Hôpital Ambroise Paré, Boulogne-Billancourt, Université de Versailles Saint Quentin en Yvelines, Paris, France
- AP-HP, Centre de référence des maladies cardiaques héréditaires, Inserm UMRS1166, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Pascale Richard
- AP-HP, UF Cardiogénétique et Myogénétique, Service de Biochimie Métabolique, Groupe Hospitalier Pitié-Salpêtrière 47-83 boulevard de l'Hôpital, Paris cedex 13 75651, France
- AP-HP, Centre de référence des maladies cardiaques héréditaires, Inserm UMRS1166, Hôpital de la Pitié-Salpêtrière, Paris, France
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Deviseti P, Pujari VS. Spinal Anaesthesia is Safe in a Patient with Wolff-Parkinson-White Syndrome Undergoing Evacuation of Molar Pregnancy. J Clin Diagn Res 2016; 10:UD01-2. [PMID: 27042562 DOI: 10.7860/jcdr/2016/15751.7182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 12/07/2015] [Indexed: 11/24/2022]
Abstract
Wolff-Parkinson-White (WPW) syndrome is an uncommon cardiac condition where there is an abnormal band of atrial tissue connecting atria and ventricles which can electrically bypass atrioventricular node. The anaesthetic management in these patients is challenging as life threatening complications can occur perioperatively like paroxysmal supraventricular tachycardia and atrial fibrillation. Also, regional anaesthetic technique like subarachnoid block is a safe and cost effective alternative to general anaesthesia as it avoids polypharmacy. We report the successful anaesthetic management of Wolff Parkinson White syndrome in a primi with hydatiform mole posted for suction and evacuation.
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Affiliation(s)
- Pravalika Deviseti
- Post Graduate Student, Department of Anesthesiology, M.S. Ramaiah Medical College & Hospitals , New BEL Road Bangalore, India
| | - Vinayak S Pujari
- Associate Professor, Department of Anesthesiology, M.S. Ramaiah Medical College & Hospitals , New BEL Road Bangalore, India
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