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Zhang Y, Ren H, Zhou S. A case report of delayed diagnosis of danon disease: Caused by a newly recognized mutation in the lysosome-associated membrane protein-2 gene. Medicine (Baltimore) 2020; 99:e22640. [PMID: 33019488 PMCID: PMC7535637 DOI: 10.1097/md.0000000000022640] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Danon disease is a rare X-linked dominant genetic disorder caused by defects in the lysosome-associated membrane protein 2 (LAMP2) gene. Unless treated, cardiogenic death is the main cause of mortality. This case report describes a 19-year-old man who was diagnosed with Danon disease and survived for 3 years from symptom onset to death. The mutation in his LAMP2 gene (p.Gly221Ilefs*19) had not been previously reported. PATIENT CONCERNS A 19-year-old man patient was hospitalized for intermittent palpitations. He had no family history of cardiomyopathy, arrhythmia, or sudden cardiac death, but his sister had died of cirrhosis at age 12 years, but the exact cause of cirrhosis was unknown. DIAGNOSIS Exome sequencing and Sanger sequencing identified a novel missense mutation (p.Gly221Ilefs*19) in the LAMP2 gene of the proband. This mutation was also detected in his mother, confirming the diagnosis of Danon disease. INTERVENTIONS The patient experienced various types of arrhythmia throughout the clinical process, including Wolff-Parkinson-White syndrome, non-sustained atrial tachycardia, atrial flutter, and third-degree atrioventricular block. He was therefore treated with cardiac ablation procedures and cardiac resynchronization therapy. OUTCOMES The period from the onset of symptoms to the onset of heart failure was 2 years. The patient died of cardiogenic death during the third year, at age 22 years. LESSONS Danon disease is a rare disease that is difficult to recognize because of its hidden early manifestations. Early identification of its clinical symptoms can lead to early diagnosis and treatment.
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Raposo D, António N, Andrade H, Sousa P, Pires A, Gonçalves L. Management of Asymptomatic Wolff-Parkinson-White Pattern in Young Patients: Has Anything Changed? Pediatr Cardiol 2019; 40:892-900. [PMID: 31069431 DOI: 10.1007/s00246-019-02110-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/27/2019] [Indexed: 11/26/2022]
Abstract
The approach to pediatric asymptomatic Wolff-Parkinson-White (WPW) patients is controversial. The objective of this review is to update the last consensus of specialists of the Pediatric and Congenital Electrophysiology Society/Heart Rhythm Society on this subject in order to summarize the most recent evidence on the management of young patients with asymptomatic WPW pattern. A systematic review of the literature published between 2008 and 2018 was performed taking into account the protocol of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) in PubMed (including Cochrane), Embase, and Web of Science. Observational, experimental, and multicentric studies were included. Out of a total of 37 articles selected, 4 were considered eligible. Most studies considered a cutoff age of 8 or greater as recommended in the 2012 consensus. The identification of a shortest pre-excitatory RR interval (SPERRI) ≤ 250 ms seems to be the best predictor for risk stratification. The importance of routine isoprenaline use to improve the sensitivity of the electrophysiological study to identify patients at high risk of sudden death was consensual. Prophylactic ablative therapy has been indicated in asymptomatic children with an accessory pathway (AP) who have a low SPERRI and/or a low effective anterograde period of the AP and/or multiple APs. Despite the evidence found in the most recent studies, more studies are warranted in this setting.
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Affiliation(s)
- Daniela Raposo
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Natália António
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
- Serviço de Cardiologia, Department of Cardiology, Coimbra Hospital and Universitary Center (Polo HUC), Praceta Mota Pinto, 3000-075, Coimbra, Portugal.
| | - Helena Andrade
- Department of Pediatric Cardiology, Coimbra Hospital and Universitary Center, Coimbra, Portugal
| | - Pedro Sousa
- Serviço de Cardiologia, Department of Cardiology, Coimbra Hospital and Universitary Center (Polo HUC), Praceta Mota Pinto, 3000-075, Coimbra, Portugal
| | - António Pires
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Department of Pediatric Cardiology, Coimbra Hospital and Universitary Center, Coimbra, Portugal
| | - Lino Gonçalves
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Serviço de Cardiologia, Department of Cardiology, Coimbra Hospital and Universitary Center (Polo HUC), Praceta Mota Pinto, 3000-075, Coimbra, Portugal
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Shaikh SA, Jamal SZ, Qadir F, Mumtaz Z, Ullah Z, Mueed A, Karim M, Irfan G. Cardiac electrophysiologic procedures - A ten years' experience at National Institute of Cardiovascular Diseases, Karachi. J PAK MED ASSOC 2019; 69:68-71. [PMID: 30623915] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To review 10 years of clinical practice of cardiac electrophysiology study and radiofrequency catheter ablation in the treatment of supraventricular tachycardia. METHODS The retrospective chart review was conducted at the National Institute of Cardiovascular Diseases, Karachi, and comprised records of all patients who underwent electrophysiological study and / or radiofrequency catheter ablation from January2007 to December 2016. SPSS 21 was used for data analysis. RESULTS Of the 627 patients, 335(53.4%) were females. The overall mean age was 40.99}13.59 years. The major indication for procedure was supraventricular tachycardia 376(59.97%). Final electrophysiological study diagnosis was typical slow fast atrioventricular nodal re-entrant tachycardia in 303(48.3%) patients. The overall success rate was 472(75.3%). Procedure-related complications were reported in 25(4%) patients, and there was 1(0.15%) mortality. CONCLUSIONS Cardiac electrophysiology studies and radiofrequency catheter ablation were found to be an effective and safe method for diagnosis and treatment of supraventricular tachycardia.
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MESH Headings
- Adult
- Catheter Ablation/adverse effects
- Catheter Ablation/methods
- Catheter Ablation/statistics & numerical data
- Diagnosis, Differential
- Electrophysiologic Techniques, Cardiac/adverse effects
- Electrophysiologic Techniques, Cardiac/methods
- Electrophysiologic Techniques, Cardiac/statistics & numerical data
- Female
- Humans
- Male
- Middle Aged
- Outcome and Process Assessment, Health Care
- Pakistan/epidemiology
- Tachycardia, Sinoatrial Nodal Reentry/diagnosis
- Tachycardia, Sinoatrial Nodal Reentry/epidemiology
- Tachycardia, Sinoatrial Nodal Reentry/therapy
- Tachycardia, Supraventricular/diagnosis
- Tachycardia, Supraventricular/epidemiology
- Tachycardia, Supraventricular/therapy
- Wolff-Parkinson-White Syndrome/diagnosis
- Wolff-Parkinson-White Syndrome/epidemiology
- Wolff-Parkinson-White Syndrome/therapy
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Affiliation(s)
| | | | - Faisal Qadir
- National Institute of Cardiovascular Diseases (NICVD), Karachi
| | - Zubair Mumtaz
- National Institute of Cardiovascular Diseases (NICVD), Karachi
| | - Zia Ullah
- National Institute of Cardiovascular Diseases (NICVD), Karachi
| | - Abdul Mueed
- National Institute of Cardiovascular Diseases (NICVD), Karachi
| | - Musa Karim
- National Institute of Cardiovascular Diseases (NICVD), Karachi
| | - Ghazala Irfan
- National Institute of Cardiovascular Diseases (NICVD), Karachi
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Song C, Guo Y, Zheng X, Lu J, Fang X, Wang S, Huang X. Prognostic Significance and Risk of Atrial Fibrillation of Wolff-Parkinson-White Syndrome in Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2018; 122:1546-1550. [PMID: 30201118 DOI: 10.1016/j.amjcard.2018.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/11/2018] [Accepted: 07/17/2018] [Indexed: 01/05/2023]
Abstract
To assess the mid-term mortality and risk of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HC) and Wolff-Parkinson-White (WPW) syndrome, 40 patients with HC and WPW were enrolled in our center between 2010 and 2017. An age- and gender-matched comparison cohort of patients with HC without WPW (n = 160) was generated from the same center. The clinical profile and outcomes were assessed. Of 40 patients with WPW, 28 underwent accessory pathway (AP) elimination. Two patients (7%) had failed in AP elimination. During mid-term follow-up, 1 patient had an implantable cardioverter-defibrillator intervention. Fourteen patients had AF. A previous history of AF (hazard ratio [HR]: 4.69; 95% confidence interval [CI] 1.51 to 14.63) and left atrial dimension (HR: 1.12; 95% CI 1.03 to 1.23) at baseline were risk factors for AF occurrence during follow-up. The AP elimination significantly reduced risk for the incidence of AF (HR: 0.22; 95% CI 0.06 to 0.83). Compared with the control group, the prevalence of syncope and AF were significantly higher in the WPW group. During follow-up, no difference was identified in outcome measures consisting of all-cause death, cardiac transplantation, and implantable cardioverter-defibrillator intervention. A previous history of AF (HR: 5.20; 95% CI 2.63 to 10.30, p <0.001) and persistent existing WPW (HR: 3.64; 95% CI 1.63 to 8.11, p = 0.002) were independent risk factors for AF occurrence during follow-up in the entire cohort. In conclusion, although WPW was uncommon and might not be correlated with mid-term mortality in HC patients, WPW might increase the risk of AF occurrence. Additionally, AP elimination may reduce the risk of AF occurrence.
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Affiliation(s)
- Changpeng Song
- Department of Special Medical Treatment Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Ying Guo
- Department of Special Medical Treatment Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Xinxin Zheng
- Department of Special Medical Treatment Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Jie Lu
- Department of Special Medical Treatment Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiaonan Fang
- Department of Special Medical Treatment Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Shuiyun Wang
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China.
| | - Xiaohong Huang
- Department of Special Medical Treatment Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China.
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Lejko Zupanc T, Logar M. Papillary Muscle Rupture in an Adolescent with No Coronary Lesions. J Heart Valve Dis 2017; 26:231-233. [PMID: 28820557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 21-year-old man with Wolff-Parkinson-White syndrome presented to the authors' hospital with ventricular fibrillation. Coronary angiography failed to demonstrate coronary stenosis, but temporary mechanical circulatory support resolved the ventricular fibrillation and the patient was extubated eight days later. On the next day, however, he had to be re-intubated with symptoms of congestive heart failure. Echocardiography revealed new severe mitral regurgitation and a mobile mass, while emergency surgery revealed a posteromedial papillary muscle rupture (PMR). The mitral regurgitation was repaired with ruptured papillary muscle relocation, artificial chordae implantation, and ring annuloplasty. Postoperative examinations suggested that an arrhythmia-induced coronary circulation hypoperfusion and septic embolization had caused the PMR.
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Affiliation(s)
- Tatjana Lejko Zupanc
- Department of Cardiovascular Surgery, Chiba University Hospital, Chiba, Japan
- Department of Cardiovascular Medicine, Chiba University Hospital, Chiba, Japan
| | - Mateja Logar
- Department of Cardiovascular Surgery, Chiba University Hospital, Chiba, Japan
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Voss F, Eckardt L, Busch S, Estner HL, Steven D, Sommer P, von Bary C, Neuberger HR. [AV-reentrant tachycardia and Wolff-Parkinson-White syndrome : Diagnosis and treatment]. Herzschrittmacherther Elektrophysiol 2016; 27:381-389. [PMID: 27878364 DOI: 10.1007/s00399-016-0466-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 12/01/2022]
Abstract
The AV-reentrant tachycardia (AVRT) is a supraventricular tachycardia with an incidence of 1-3/1000. The pathophysiological basis is an accessory atrioventricular pathway (AP). Patients with AVRT typically present with palpitations, an on-off characteristic, anxiety, dyspnea, and polyuria. This type of tachycardia may often be terminated by vagal maneuvers. Although the clinical presentation of AVRT is quite similar to AV-nodal reentrant tachycardias, the correct diagnosis is often facilitated by analyzing a standard 12-lead ECG at normal heart rate showing ventricular preexcitation. Curative catheter ablation of the AP represents the therapy of choice in symptomatic patients. This article is the fourth part of a series written to improve the professional education of young electrophysiologists. It explains pathophysiology, symptoms, and electrophysiological findings of an invasive EP study. It focusses on mapping and ablation of accessory pathways.
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Affiliation(s)
- Frederik Voss
- Innere Medizin III, Krankenhaus der Barmherzigen Brüder Trier, Nordallee 1, 54290, Trier, Deutschland.
| | - Lars Eckardt
- Abteilung für Rhythmologie, Department für Kardiologie und Angiologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Sonia Busch
- Medizinische Klinik für Kardiologie, Angiologie und Pneumologie, Klinikum Coburg, Coburg, Deutschland
| | - Heidi L Estner
- Medizinische Klinik und Poliklinik I, Universitätsklinikum München-Großhadern, München, Deutschland
| | - Daniel Steven
- Klinik III für Innere Medizin, Herzzentrum Uniklinik Köln, Köln, Deutschland
| | - Philipp Sommer
- Abteilung für Rhythmologie, Herzzentrum Leipzig, Leipzig, Deutschland
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Xie C, Zhang YP, Song L, Luo J, Qi W, Hu J, Lu D, Yang Z, Zhang J, Xiao J, Zhou B, Du JL, Jing N, Liu Y, Wang Y, Li BL, Song BL, Yan Y. Genome editing with CRISPR/Cas9 in postnatal mice corrects PRKAG2 cardiac syndrome. Cell Res 2016; 26:1099-1111. [PMID: 27573176 PMCID: PMC5113300 DOI: 10.1038/cr.2016.101] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [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: 06/19/2016] [Revised: 07/10/2016] [Accepted: 07/11/2016] [Indexed: 01/04/2023] Open
Abstract
PRKAG2 cardiac syndrome is an autosomal dominant inherited disease resulted from mutations in the PRKAG2 gene that encodes γ2 regulatory subunit of AMP-activated protein kinase. Affected patients usually develop ventricular tachyarrhythmia and experience progressive heart failure that is refractory to medical treatment and requires cardiac transplantation. In this study, we identify a H530R mutation in PRKAG2 from patients with familial Wolff-Parkinson-White syndrome. By generating H530R PRKAG2 transgenic and knock-in mice, we show that both models recapitulate human symptoms including cardiac hypertrophy and glycogen storage, confirming that the H530R mutation is causally related to PRKAG2 cardiac syndrome. We further combine adeno-associated virus-9 (AAV9) and the CRISPR/Cas9 gene-editing system to disrupt the mutant PRKAG2 allele encoding H530R while leaving the wild-type allele intact. A single systemic injection of AAV9-Cas9/sgRNA at postnatal day 4 or day 42 substantially restores the morphology and function of the heart in H530R PRKAG2 transgenic and knock-in mice. Together, our work suggests that in vivo CRISPR/Cas9 genome editing is an effective tool in the treatment of PRKAG2 cardiac syndrome and other dominant inherited cardiac diseases by selectively disrupting disease-causing mutations.
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Affiliation(s)
- Chang Xie
- Hubei Key Laboratory of Cell Homeostasis, College of Life Sciences, Wuhan University, Wuhan 430072, China
- The State Key Laboratory of Molecular Biology, Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 320 Yue-Yang Road, Shanghai 200031, China
| | - Ya-Ping Zhang
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Lu Song
- The State Key Laboratory of Molecular Biology, Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 320 Yue-Yang Road, Shanghai 200031, China
| | - Jie Luo
- Hubei Key Laboratory of Cell Homeostasis, College of Life Sciences, Wuhan University, Wuhan 430072, China
| | - Wei Qi
- The State Key Laboratory of Molecular Biology, Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 320 Yue-Yang Road, Shanghai 200031, China
| | - Jialu Hu
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Danbo Lu
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zhen Yang
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jian Zhang
- The State Key Laboratory of Molecular Biology, Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 320 Yue-Yang Road, Shanghai 200031, China
| | - Jian Xiao
- Hubei Key Laboratory of Cell Homeostasis, College of Life Sciences, Wuhan University, Wuhan 430072, China
| | - Bin Zhou
- Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 320 Yue-Yang Road, Shanghai 200031, China
| | - Jiu-Lin Du
- Institute of Neuroscience and State Key Laboratory of Neuroscience, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 320 Yue-Yang Road, Shanghai 200031, China
| | - Naihe Jing
- The State Key Laboratory of Molecular Biology, Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 320 Yue-Yang Road, Shanghai 200031, China
| | - Yong Liu
- Hubei Key Laboratory of Cell Homeostasis, College of Life Sciences, Wuhan University, Wuhan 430072, China
| | - Yan Wang
- Hubei Key Laboratory of Cell Homeostasis, College of Life Sciences, Wuhan University, Wuhan 430072, China
| | - Bo-Liang Li
- The State Key Laboratory of Molecular Biology, Institute of Biochemistry and Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, 320 Yue-Yang Road, Shanghai 200031, China
| | - Bao-Liang Song
- Hubei Key Laboratory of Cell Homeostasis, College of Life Sciences, Wuhan University, Wuhan 430072, China
| | - Yan Yan
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Gilhofer TS, Fauchère I, Brunckhorst C. [CME: WPW syndrome]. Praxis (Bern 1994) 2015; 104:1301-1313. [PMID: 26602846 DOI: 10.1024/1661-8157/a002211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Thomas S Gilhofer
- 1 Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich
| | - Ivan Fauchère
- 1 Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich
| | - Corinna Brunckhorst
- 1 Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich
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Mandel WJ, Yamaguchi I, Laks MM. Syndromes of accelerated conduction. Adv Cardiol 2015:80-93. [PMID: 619526 DOI: 10.1159/000401019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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10
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Ward NJ, Fox CJ, Kralik KS, Haydar S, Saucier JR. 4 EKG abnormalities: what are the lifesaving diagnoses? J Fam Pract 2014; 63:368-375. [PMID: 25198210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Nathaniel J Ward
- Tufts University School of Medicine, Main Medical Center, Department of Emergency Medicine, Portland, USA.
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12
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Miller DC. You're the flight surgeon: Wolff-Parkinson-White. ACTA ACUST UNITED AC 2014; 85:487-9. [PMID: 24754217 DOI: 10.3357/asem.3694.2014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ozenc S, Iscen S, Kibrisli E, Tok D, Parlak A, Altinel O, Altinel S. Prophylactic accessory-pathway ablation in asymptomatic patients with a Wolff-Parkinson-White electrocardiographic pattern. Eur Rev Med Pharmacol Sci 2014; 18:981-984. [PMID: 24763877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The optimal approach is controversial in asymptomatic patients who are coincidentally found to have evidence of an accessory pathway (AP) on an ECG. The risk of sudden cardiac death (SCD) is low, and the risk of developing symptoms also appears to be low, although a wide range of incidences have been reported. In our trial, we tested the hypothesis that if prophylactic accessory-pathway ablation performed at the time of the initial electrophysiological testing would improve the long-term outcome in asymptomatic patients with a Wolff-Parkinson-White electrocardiographic pattern. PATIENTS AND METHODS Recruitment of patients began on February 1, 2004, and ended on February 5, 2009. All 110 asymptomatic patients were hospitalized and underwent electrophysiological testing the same day to assess the inducibility of atrioventricular reciprocating tachycardia. The anterograde effective refractory period of the accessory pathway was defined as the longest coupling interval at which anterograde block in the bypass tract was observed. For the statistical analysis, the statistical software SPSS version 15.0 for Windows (SPSS Inc., Chicago, IL, USA). RESULTS Of 110 asymptomatic patients with a Wolff-Parkinson-White electrocardiographic pattern, 80 patients were ablated. Ablation group consisted of these patients. Control group consisted of remaining 30 and were divided into two groups according to the anterograde effective refractory period of the accessory pathway. There was no significant difference between three groups in terms of arrhythmic events (p: 0.58). CONCLUSIONS Asymptomatic patients with the Wolff-Parkinson-White syndrome do not require prophylactic ablation, since they remain asymptomatic for many years.
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Affiliation(s)
- S Ozenc
- Department of Family Medicine, Department of Cardiology, and Department of Surgery, Diyarbakir Military Hospital, Yenisehir, Diyarbakir, Turkey.
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Xiao W, Duan Q, Zhao L, Wang F, Wang T. Goal directed fluid therapy with LiDCO(rapid) in a parturient with WPW syndrome and cardiac dysfunction undergoing emergent cesarean section. Chin Med J (Engl) 2014; 127:2719-2720. [PMID: 25043098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Affiliation(s)
- Wei Xiao
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Qingfang Duan
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Lei Zhao
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Fengying Wang
- Department of Obstetrics and Gynecology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Tianlong Wang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
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Katsuragi S, Kamiya C, Yamanaka K, Neki R, Miyoshi T, Iwanaga N, Horiuchi C, Tanaka H, Yoshimatsu J, Niwa K, Ikeda T. Risk factors for maternal and fetal outcome in pregnancy complicated by Ebstein anomaly. Am J Obstet Gynecol 2013; 209:452.e1-6. [PMID: 23860210 DOI: 10.1016/j.ajog.2013.07.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [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: 04/12/2013] [Revised: 06/02/2013] [Accepted: 07/01/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The goal of the study was to examine risks in pregnancy in patients with Ebstein anomaly. STUDY DESIGN Data were examined retrospectively for 13 patients (27 pregnancies, 21 live births) with Ebstein anomaly during pregnancy who were treated at our institution from 1985 to 2011. The associated anomalies in these patients were atrial septal defect (ASD) (n = 4) and the Wolff-Parkinson-White syndrome (n = 6). RESULTS Before pregnancy, 2 patients underwent ASD closure and 1 received tricuspid valve replacement (TVR). In all patients, the cardiothoracic ratio increased from 55.1 at conception to 57.0 during pregnancy and 58.0 postpartum (P < .05). Cesarean sections were performed in 3 cases: 1 with ventricular tachycardia and orthopnea (New York Heart Association [NYHA] III) preterm; at full term, and the third in a patient with a mechanical tricuspid valve who developed maternal cerebellum hemorrhage at 27 weeks. The baby died of prematurity in the third case. In all other cases (20 of 21), neonatal prognoses were good without congenital heart diseases. There were 6 spontaneous abortions. Recurrent paroxysmal supraventricular tachycardia occurred during pregnancy in 2 cases and was treated with adenosine triphosphate or verapamil. In 17 pregnancies, NYHA remained in class I and all had full-term vaginal delivery. CONCLUSION Maternal and fetal outcomes are good in patients with Ebstein anomaly and NYHA class I. However, pregnancy in Ebstein anomaly can be complicated with tachyarrhythmia or cardiac failure. In post-TVR cases, meticulous care is required for these complications during pregnancy and delivery.
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Affiliation(s)
- Shinji Katsuragi
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Osaka, Japan.
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Miller S, Parker M, Blasiole N, Beinlich N, Fulton J. A prospective, in vivo evaluation of two pressure-redistribution surfaces in healthy volunteers using pressure mapping as a quality control instrument . Ostomy Wound Manage 2013; 59:44-48. [PMID: 23388397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Deep tissue injury (DTI) can rapidly evolve into a higher stage pressure ulcer. Use of pressure-redistribution surfaces is a widely accepted practice for the prevention of pressure ulcers in acute care patients, particularly in departments where care processes limit mobility. A 15-year-old patient developed a sacral DTI 24 hours after completion of a lengthy (12- hour) electrophysiology (EP) study and catheter ablation. A root cause analysis (RCA) conducted to investigate the origin of the hospital-acquired suspected DTI prompted a small investigation to evaluate the pressure-distribution properties of the EP lab surface and an OR table pad. Five healthy adult employee volunteers were evaluated in the supine position by placing a sensing mat between the volunteer and the test surface. Interface pressures (on a scale of 0 mm Hg to 100 mm Hg) were captured after a "settling in" time of 4 minutes, and the number of sensors registering very high pressures (above 90 mm Hg) across the surface were recorded. On the OR table pad, zero to six sensors registered >90 mm Hg compared to two to 20 sensors on the EP lab surface. These data, combined with the acquired DTI, initiated a change in EP lab surfaces. Although interface pressure measurements only provide information about one potential support surface characteristic, it can be helpful during an RCA. Studies to compare the effect of support surfaces in all hospital units on patient outcomes are needed.
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Ushakov IB, Ardashev AV, Ardashev VN, Voronkov II, Sharoĭko MV, Akimova OS. [Evaluation of the radiofrequency ablation effectiveness in patients with the Wolff-Parkinson-White syndrome]. Aviakosm Ekolog Med 2012; 46:68-71. [PMID: 23074955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A one-year prospective study involved 22 patients with the Wolff-Parkinson-White syndrome (WPW) and 20 healthy people. Means age of patients was 34.3 +/- 16.3 years. All 22 patients were successfully treated with radiofrequency ablation (RFA) of additional pathways. RFA effectiveness was evaluated with the help of clinical questionnaire, data of ECG, EchoCG, heart rate variability (HRV), frequency response and nonlinear dynamics. Cardiac rhythm disturbances were verified using Holter monitoring applied to all patients. Positive clinical effect was achieved in all the WPW patients, as RFA arrested cardiac arrhythmias completely. Holter monitoring did not register cardiac disturbances which points to high RFA effectiveness in WPW patients. HRV, frequency response and nonlinear dynamics reassumed their normal patterns.
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Takahashi N, Shinohara T, Hara M, Saikawa T. Wolff-Parkinson-White syndrome concomitant with idiopathic ventricular fibrillation associated with inferior early repolarization. Intern Med 2012; 51:1861-4. [PMID: 22821101 DOI: 10.2169/internalmedicine.51.7353] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We encountered a 39-year-old man with documented ventricular fibrillation (VF). His ECGs showed intermittent Wolff-Parkinson-White (WPW) syndrome pattern. During electrophysiological study, no ventricular preexcitation was observed. An accessory pathway located at the posterior mitral annulus was identified, and successfully eliminated by radiofrequency catheter ablation. VF was not induced. His ECGs in the absence of delta waves demonstrated early repolarization in the inferior leads. This case raises the possibility that patients with manifest WPW syndrome may have an arrhythmogenic substrate associated with early repolarization, and the characteristic J waves can be masked by the presence of ventricular preexcitation.
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Affiliation(s)
- Naohiko Takahashi
- Department of Laboratory Examination and Diagnostics, Faculty of Medicine, Oita University, Japan.
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Kulawik T, Kałuża B, Kuśnierz J. [Acute coronary syndrome during dissection of left main as a complication of radiofrequency ablation]. Kardiol Pol 2012; 70:190-193. [PMID: 22427091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We present a case of 44 year-old female who was admitted to the hospital due to performed radio frequency ablation because of VF during WPW syndrome, which was complicated by dissection of left main. The dissection was treated with success by primary percutaneous coronary intervention with two metal stents.
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Aziz F, Kanal R, Butt S, Penupolu S, Ameen A. Aberrant pathway in an anomaly: pre-excitation syndrome in association with coronary sinus aneurysm. Cardiovasc J Afr 2011; 22:141-143. [PMID: 21713304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Accepted: 04/22/2010] [Indexed: 05/31/2023] Open
Abstract
Congenital coronary sinus anomalies are unusual and they rarely coexist with accessory atrio-ventricular pathways. These anomalies are generally symptomatic; however they can cause difficulty in mapping. The association between accessory pathway and coronary sinus anomalies may suggest an embryological link. Here, we report on a male patient with an accessory conducting pathway in the coronary sinus, leading to Wolff-Parkinson-White (WPW) syndrome.
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Affiliation(s)
- F Aziz
- Department of Internal Medicine, Jersey City Medical Center, New Jersey, USA.
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Brace S. Emergency treatment of Wolff-Parkinson-White syndrome. Emerg Nurse 2011; 18:36-39. [PMID: 21384785 DOI: 10.7748/cnp.v1.i3.pg21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This article describes the aetiology of Wolff-Parkinson-White syndrome and discusses the benefits and disadvantages of some of the available cardioversion medications with which it can be treated.
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Belenkov IN, Rybachenko MS, Zheliakov EG, Konev AV, Ardashev AV, Butaev TD. [Echocardiographic parameters in patients with Wolf-Parkinson-White syndrome before and during one year after radiofrequency catheter ablation of accessory atrioventricular junction]. Kardiologiia 2011; 51:32-38. [PMID: 21878083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We present in this paper results of assessment of morphofunctional state of myocardium in patients with the Wolf-Parkinson-White syndrome before and during one year after radiofrequency catheter ablation (RFA) of accessory atrioventricular junction (AAVJ) and comparison of them with analogous parameters of the group of healthy volunteers as well as in dependence on electrophysiological properties of AAVJ and its localization. One hundred sixty patients took part in the conducted study: main group comprised 160 patients (80.7%) with WPW syndrome (114 men [81.4%], 26 women [18.6%], mean age 39.5+/-15.3 years), comparison group comprised 20 practically healthy persons (15 men [75.0%], 5 women [25%], mean age 41.9+/-5.3 years). All main group patients were subjected to endocardial electrophysiological investigation and RFA of AAVJ. Transthoracic echocardiography (EchoCG) was carried out in patients of main group before and in 2, 6, and 12 months after operation of RFA of AAVJ, and once in control group. Analysis of parameters of central hemodynamics according to data of transthoracic EchoCG in patients with WPW syndrome before RFA of AAVJ demonstrated that before conduct of operative intervention no significant differences were revealed in the studied parameters compared with analogous characteristics of the clinical comparison group. During whole period of dynamic observation (2, 6, and 12 months after fulfilled RFA of AAVJ) in patients with WPW syndrome the studied parameters of central hemodynamics did not undergo substantial changes compared with initial characteristics. We failed to establish significant differences of EchoCG parameters in patients with WPW syndrome in dependence on electrophysiological properties of AAVJ (concealed, manifest) and on AAVJ localization (right, left, septal). According to EchoCG data in patients with WPW syndrome so called "minor" anomalies of development of connective tissue of the heart were diagnosed in 69 (49.3%) patients while in control group - in 2 (10%) patients.
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Iturralde-Torres P, Márquez MF. Contributions of the Instituto Nacional de Cardiología in the diagnosis and treatment of the Wolff-Parkinson - White syndrome. Arch Cardiol Mex 2010; 80:329-337. [PMID: 21169099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Since the first description of the disease now known as Wolff-Parkinson-White syndrome, much knowledge has been gained through several experimental and clinical studies all over the world. The Instituto Nacional de Cardiología Ignacio Chávez in Mexico City has not been the exception. In this report, we describe the clinical, electrocardiographic and electrophysiologic contributions of past and present researchers at the Institute, as well as the experience in the diagnosis and treatment of the W-P-W syndrome at this Instituto Nacional de Cardiología Ignacio Chávez.
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De Boeck BWL, Teske AJ, Leenders GE, Mohamed Hoesein FAA, Loh P, van Driel VJ, Doevendans PA, Prinzen FW, Cramer MJ. Detection and quantification by deformation imaging of the functional impact of septal compared to free wall preexcitation in the Wolff-Parkinson-White syndrome. Am J Cardiol 2010; 106:539-546.e2. [PMID: 20691313 DOI: 10.1016/j.amjcard.2010.03.066] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 03/30/2010] [Accepted: 03/30/2010] [Indexed: 11/30/2022]
Abstract
Pacing experiments in healthy animal hearts have suggested a larger detrimental effect of septal compared to free wall preexcitation. We investigated the intrinsic relation among the site of electrical preexcitation, mechanical dyssynchrony, and dysfunction in human patients. In 33 patients with Wolff-Parkinson-White (WPW) syndrome and 18 controls, regional myocardial deformation was assessed by speckle tracking mapping (ST-Map) to assess the preexcitation site, shortening sequences and dyssynchrony, and the extent of local and global ejecting shortening. The ST-Map data in patients with accessory atrioventricular pathways correctly diagnosed as located in the interventricular septum (IVS) (n = 11) or left ventricular free wall (LFW) (n = 12) were compared to the corresponding control values. A local ejecting shortening of <2 SD of the control values identified hypokinetic segments. The localization of the atrioventricular pathways by ST-Map matched with the invasive electrophysiology findings in 23 of 33 patients and was one segment different in 5 of 33 patients. In both WPW-IVS and WPW-LFW, local ejecting shortening was impaired at the preexcitation site (p <0.01). However, at similar electrical and mechanical dyssynchrony, WPW-IVS had more extensive hypokinesia than did WPW-LFW (3.6 +/- 0.9 vs 1.8 +/- 1.3 segments, p <0.01). Compared to controls, the left ventricular function was significantly reduced only in WPW-IVS (global ejecting shortening 17 +/- 2% vs 19 +/- 2%, p = 0.01; ejection fraction 55 +/- 5% vs 59 +/- 3%, p = 0.02). In conclusion, preexcitation is associated with local hypokinesia, which at comparable preexcitation is more extensive in WPW-IVS than in WPW-LFW and could adversely affect ventricular function. ST-Map might have a future role in detecting and guiding treatment of septal pathways with significant mechanical effects.
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Abstract
Wolff-Parkinson-White (WPW) syndrome is a ventricular preexcitation that presents as supraventricular tachycardia. Health care professionals can attain optimal results in caring for infants with WPW syndrome by understanding both its pathophysiology and proper management to prevent and treat complications associated with it. This article reviews the prevalence, pathophysiology, clinical manifestations, diagnostic modalities, assessment, and management of WPW syndrome.
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Ritscher G, Simon H, Nölker G, Brachmann J, Sinha AM. [Electrophysiologic diagnosis and therapy]. Med Klin (Munich) 2010; 105:416-430. [PMID: 20582502 DOI: 10.1007/s00063-010-1078-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
MESH Headings
- Aged
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/therapy
- Bradycardia/diagnosis
- Bradycardia/etiology
- Bradycardia/therapy
- Combined Modality Therapy
- Coronary Artery Bypass
- Coronary Restenosis/diagnosis
- Coronary Restenosis/therapy
- Defibrillators, Implantable
- Diagnosis, Differential
- Electrocardiography, Ambulatory
- Graft Occlusion, Vascular/diagnosis
- Graft Occlusion, Vascular/therapy
- Humans
- Male
- Myocardial Infarction/surgery
- Pacemaker, Artificial
- Patient Care Team
- Postoperative Complications/diagnosis
- Postoperative Complications/etiology
- Postoperative Complications/therapy
- Signal Processing, Computer-Assisted
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/etiology
- Tachycardia, Ventricular/therapy
- Wolff-Parkinson-White Syndrome/diagnosis
- Wolff-Parkinson-White Syndrome/etiology
- Wolff-Parkinson-White Syndrome/therapy
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Affiliation(s)
- Guido Ritscher
- II. Medizinische Klinik, Klinikum Coburg, Coburg, Germany
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Ulger Z, Karapinar B, Akyol B, Arslan MT, Levent E, Ozyürek AR. A case with Wolf-Parkinson-White syndrome first presented with a devastating event: aborted sudden cardiac death. Anadolu Kardiyol Derg 2009; 9:70-71. [PMID: 19196585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Ardashev AV, Rybachenko MS, Zheliakov EG, Shavarov AA, Voloshko SV. [Wolff--Parkinson--White syndrome: classification, clinical manifestations, diagnosis, and treatment]. Kardiologiia 2009; 49:77-87. [PMID: 19845525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Main etiological factors, mechanisms of arrhythmogenesis, and classification of Wolff-Parkinson-White (WPW) syndrome are presented and clinico-electrocardiographical and electrophysiological peculiarities of atrioventricular reciprocal tachycardia in this syndrome are described. Main diagnostic measures, principles of their correct interpretation are specified and principles of tactical approach to management of patients are presented. Indications to electrophysiological investigation and radiofrequency catheter ablation, physical characteristics of radiofrequency action in regions of optimal mapping of supplementary atrioventricular junction are discussed. Data of analysis of efficacy of pharmacological and interventional approaches to the treatment of patients with WPW syndrome are also presented.
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30
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Michowitz Y, Belhassen B. [Wolff-Parkinson-White syndrome--diagnosis and treatment]. Harefuah 2008; 147:920-921. [PMID: 19264016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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31
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Sen N, Okuyan H, Türkoğlu S, Tavil Y, Ozdemir M. The missing diagnosis in patients with wide QRS complex tachycardia: WPW syndrome with atrial fibrillation. Anadolu Kardiyol Derg 2008; 8:E4-E5. [PMID: 18258520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Nihat Sen
- Department of Cardiology, Faculty of Medicine, Gazi University, Beşevler, Ankara, Turkey.
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32
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Ghosh S, Avari JN, Rhee EK, Woodard PK, Rudy Y. Noninvasive electrocardiographic imaging (ECGI) of a univentricular heart with Wolff-Parkinson-White syndrome. Heart Rhythm 2008; 5:605-8. [PMID: 18325851 DOI: 10.1016/j.hrthm.2007.12.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Accepted: 12/14/2007] [Indexed: 11/17/2022]
Affiliation(s)
- Subham Ghosh
- Cardiac Bioelectricity and Arrhythmia Center, Washington University, St Louis, MO 63130-4899, USA
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33
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Aronow WS. Management of atrial fibrillation--Part 2. Compr Ther 2008; 34:134-142. [PMID: 19137754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Many cardiologists prefer, especially in older patients, ventricular rate control plus warfarin rather than maintaining sinus rhythm with anti-arrhythmic drugs. Patients with chronic or paroxysmal AF at high risk for stroke should be treated with long-term warfarin to achieve an International Normalized Ratio of 2.0 to 3.0. Patients with AF at low risk for stroke or with contraindications to warfarin should be treated with aspirin.
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Affiliation(s)
- Wilbert S Aronow
- Cardiology Division, New York Medical College, Macy Pavilion, Room 138, Valhalla, NY 10595, USA.
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Harish A, Mullasari AS, Pandurangi UM. Memory T sign. J Assoc Physicians India 2007; 55:564. [PMID: 18019798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- A Harish
- Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai
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37
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Sethi KK, Dhall A, Chadha DS, Garg S, Malani SK, Mathew OP. WPW and preexcitation syndromes. J Assoc Physicians India 2007; 55 Suppl:10-15. [PMID: 18368860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Wolff-Parkinson-White syndrome is a disorder characterized by presence of an accessory pathway which predisposes patients to tachyarrhythmias and sudden death. Among patients with WPW syndrome, atrioventricular reentrant tachycardia (AVRT) is the most common arrhythmia, accounting for 95% of re-entrant tachycardias. It has been estimated that one-third of patients with WPW syndrome have atrial fibrillation (AF). AF is a potentially life-threatening arrhythmia. If an accessory pathway has a short anterograde refractory period, then rapid repetitive conduction to the ventricles during AF can result in a rapid ventricular response with subsequent degeneration to ventricular fibrillation (VF). The accessory pathway may be located anywhere along the atrioventricular valve Most of the patients are young and do not have structural heart disease hence it is important to risk stratify these patients so as to prevent the sudden death. Management of asymptomatic patients with WPW syndrome has always remained controversial Catheter ablation of accessory pathways has become an established mode of therapy for symptomatic patients and asymptomatic patients employed in high-risk professions.
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Affiliation(s)
- K K Sethi
- Delhi Heart and Lung Institute, New Delhi
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Fichet J, Legras A, Bernard A, Babuty D. Aborted Sudden Cardiac Death Revealing Isolated Noncompaction of the Left Ventricle in a Patient with Wolff-Parkinson-White Syndrome. Pacing Clin Electro 2007; 30:444-7. [PMID: 17367369 DOI: 10.1111/j.1540-8159.2007.00690.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Isolated noncompaction of the left ventricle (INLV) is a rare congenital disorder associated with multiple cardiac arrhythmias. We report a case of INLV revealed by ventricular fibrillation in a patient with Wolff-Parkinson-White syndrome. Because of the persistence of inducible ventricular arrhythmias after ablation of the accessory pathway, implantation of an ICD was decided.
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Affiliation(s)
- Jérôme Fichet
- Intensive Care Unit, Centre Hospitalier Universitaire de Tours, 37044 Tours, France
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Lee KT, Chu CS, Lu YH, Lin TH, Yen HW, Voon WC, Sheu SH, Lai WT. Modulation of the expression of long-term cardiac memory by short-term cardiac memory in patients with Wolff-Parkinson-White syndrome after catheter ablation. Circ J 2007; 71:331-7. [PMID: 17322630 DOI: 10.1253/circj.71.331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The interaction between long-and short-term cardiac memory (CM) is unknown. METHODS AND RESULTS The T-wave areas and QTc intervals in each ECG lead were analyzed in 11 patients with manifest Wolff-Parkinson-White syndrome with posterior or septal accessory pathway (4 females; mean age: 47+/-12 years) in the following ECGs: (1) immediately after catheter ablation (post-ablation ECG); (2) immediately after 20 min of right ventricular outlet pacing (post-pacing ECG); and (3) 1 week after ablation (recovery ECG). Compared with the post-ablation ECGs, the T-wave areas of the recovery ECGs in leads II and aV(F) changed dramatically from negative to positive while that in lead III became less negative (p<0.01), and those in leads I, aV(L), and V(2-4) became less positive (p<0.05). Compared with the post-ablation ECGs, the T-wave areas of the post-pacing ECGs in leads III and aV(F) became less negative (p<0.01), and those in leads I, aV(L), and V(2-4) became less positive (p<0.05). The QTc interval in the post-ablation ECG was significantly longer than in either the post-pacing or recovery ECGs (p<0.05). CONCLUSIONS Mechanisms involved in the expression of long-term CM could be affected by short-term CM.
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Affiliation(s)
- Kun-Tai Lee
- Department of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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40
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Abstract
Spontaneous conduction during the supernormal period (SNP) of accessory pathways (AP) is rare and observed only during atrio-ventricular block (AVB). The effect of exercise and different escape rhythms on the SNP is unknown. We evaluated these factors on the SNP of a para-Hisian AP after a failed ablation complicated by AVB. The SNP onset and duration were later and longer during paced versus junctional rhythm. Exercise caused linear shortening of the SNP that was directly related to junctional cycle length. The SNP is a dynamic window shifting in parallel with AP refractoriness and affected by exercise and type of escape rhythm.
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Affiliation(s)
- Jeremy J Lum
- Department of Medicine, University of Hawaii, Honolulu, Hawaii, USA
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41
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Abstract
A 24-year-old pregnant woman was referred to our hospital for the evaluation of her cardiac function. An electrocardiogram showed Wolff-Parkinson-White syndrome. Echocardiography revealed prominent trabeculation and deep intertrabecular recesses at the left ventricular apex and mid-portion of the inferior and lateral wall, with an impaired ejection fraction. She was diagnosed as having an isolated noncompaction of the ventricular myocardium (INVM). As the pregnancy progressed, severe restrictive hemodynamics became apparent. In consideration of the fetal growth, we decided to deliver the fetus by cesarean section at 32 weeks gestation; the patient successfully delivered a female infant. Interestingly, echocardiography demonstrated INVM in both the child and mother. This report is the first description of a successful pregnancy in a patient with familial INVM.
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Affiliation(s)
- Yoshiko Munehisa
- Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Akita University School of Medicine
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Affiliation(s)
- Amit Saxena
- University of California, Berkeley, University Health Services and Department of Intercollegiate Athletics, 2222 Bancroft Way, Berkeley, CA 94720, USA
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Mansour F, Basmadjian AJ, Bouchard D, Ibrahim R, Guerra PG, Khairy P. Images in cardiovascular medicine. Left ventricular pseudoaneurysm: a late complication of low-energy DC ablation. Circulation 2006; 113:e780-1. [PMID: 16735682 DOI: 10.1161/circulationaha.105.591008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Fadi Mansour
- Department of Cardiology, Montreal Heart Institute, Montreal, Canada
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Abstract
PURPOSE OF REVIEW As the safety and efficacy of invasive electrophysiologic studies and ablation therapy in pediatrics improves, there has been a greater interest in developing adequate risk stratification criteria for the asymptomatic pediatric patient with Wolff-Parkinson-White syndrome. This review will discuss the recent literature regarding this debate. RECENT FINDINGS Recent retrospective and prospective studies of Wolff-Parkinson-White syndrome in asymptomatic pediatric patients have shown that the well established adult criteria for risk stratification may not be applicable in children. Both symptomatic and asymptomatic children had similar accessory pathway effective refractory periods and supraventricular tachycardia inducibility in recent invasive electrophysiologic studies. The first attempt at prospective evaluation of the use of ablation therapy in asymptomatic adult and pediatric patients with the condition has sparked a debate as to the definition of a high-risk patient and the utility of ablation in the asymptomatic patient. SUMMARY It is still controversial whether the established criteria for risk stratification in adults can be confidently applied to the pediatric patient. The majority of pediatric electrophysiologists use invasive electrophysiologic studies for risk stratification and selection of appropriate therapy. This clinical practice reflects the increasing prevalence and safety of electrophysiologic study and ablation. Further studies to better define indications for study and ablation are still necessary, however, to define accurate criteria for risk stratification in this difficult pediatric problem.
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Affiliation(s)
- Alisa L Niksch
- Pediatric Arrhythmia Center at University of California San Francisco and Stanford, Palo Alto and San Francisco, California, USA
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Affiliation(s)
- Alexander Mazur
- Department of Cardiology, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel.
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46
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Szilágyi SM, Szilágyi L, Benyó Z. Sensibility analysis of the Arruda localization method. Conf Proc IEEE Eng Med Biol Soc 2006; 2006:3998-4001. [PMID: 17946213 DOI: 10.1109/iembs.2006.259589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This paper presents an analysis of the Arruda accessory pathway localization method (for patients suffering from Wolff-Parkinson-White syndrome) with suggestions to increase the overall performance. The Arruda method was tested on a total of 121 patients, and a 90% localization performance was reached. This was considered almost as performing result as the highest published (90%) by L. Boersma in 2002. After a deeper analysis of each decision point of Arruda localization method we considered that the lead AVF is not as relevant as other used leads (I, II, III, VI). The overall performance (90%) was slightly lower then the correct decision rate (91.67%) at the weakest decision element (AVF+) of the method. The vectorial space constructed from the most used leads (II, VI, AVF) is not orthogonal which can be a reason for weaker rate in case of AVF.
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Abstract
BACKGROUND There remains to be issues regarding radiofrequency catheter ablation (RFCA) in pediatric patients that are different to those involving adults. This study was performed to determine the efficacy and safety of RFCA in pediatric patients. METHODS AND RESULTS During the period from 1992 to 2003, 2,734 patients underwent RFCA and 131 pediatric patients who were < or =15 years old (70 males, mean age 12.0+/-3.1 years) were analyzed, retrospectively. The number of accessory pathways (APs) mediating atrioventricular re-entrant tachycardia was 93 (71.4%) and atrioventricular nodal re-entrant tachycardia (AVNRT) was 27 (20.5%). The most common indications for the RFCA were the ;patient's choice' in 94 (71.2%) and 'medically refractory tachycardia' in 29 (22.0%). The age-related indication of the ;patient's choice' was 80.4% (82 of 102) for those >10 years old and 40.0% (12 of 30) for those < or =10 years old (p=0.01). RFCA was performed without sedation in 87.3% (89 of 102) of the subjects >10 years old as compared to 20.0% (6 of 30) of those < or =10 years old (p=0.01). The success rate was 92.8% (90 of 97 APs) for the ablation of APs, and 96.3% (26 of 27) for that of AVNRT. The overall complication rate was 3.8% (5 of 131). During a mean follow-up duration of 13.1+/-2.5 months, the freedom of recurrence was 87.8% (79 of 90) for the arrhythmia associated with APs and 92.3% (24 of 26) for AVNRT. CONCLUSION RFCA in pediatric patients had a good success rate with acceptable recurrence and complication rates when compared to adult patient results. Therefore, RFCA could be considered as the first line of therapy for arrhythmias with concealed and manifested APs and AVNRT in pediatric patients.
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Affiliation(s)
- Boyoung Joung
- Division of Cardiology, Yonsei Cardiovascular Hospital and Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Takahashi N, Ooie T, Nakagawa M, Hara M, Saikawa T, Yoshimatsu H. Progressive facilitation of antegrade conduction via an accessory pathway in a patient with Wolff-Parkinson-White syndrome and permanent atrial fibrillation. Intern Med 2005; 44:1264-8. [PMID: 16415547 DOI: 10.2169/internalmedicine.44.1264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The case of a 64-year-old man with Wolff-Parkinson-White syndrome and permanent atrial fibrillation (AF) is reported. The patient was admitted due to electrocardiographic feature of AF with rapid conduction over the left-sided accessory pathway. Administration of pirmenol effectively suppressed the ventricular response via an accessory pathway. A transesophageal echocardiography detected an uncertain thrombus in the left atrial appendage. During the 33-month follow-up period, the ventricular response via an accessory pathway was progressively facilitated. Radiofrequency catheter ablation using a transseptal approach was performed during AF, resulting in complete elimination of the antegrade accessory pathway conduction.
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Affiliation(s)
- Hein J Wellens
- Cardiovascular Research Institute Maastricht, 21 Henric van Veldekeplein, 6211 TG Maastricht, The Netherlands.
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Pappone C, Santinelli V. Should catheter ablation be performed in asymptomatic patients with Wolff-Parkinson-White syndrome? Catheter ablation should be performed in asymptomatic patients with Wolff-Parkinson-White syndrome. Circulation 2005; 112:2207-15; discussion 2216. [PMID: 16208793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Carlo Pappone
- Department of Cardiology, San Raffaele University Hospital, 20132 Milan, Italy.
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