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Kurath-Koller S, Sallmon H, Scherr D. Ventricular insertion site ablation of a Mahaim atriofascicular fibre in Ebstein anomaly. Cardiol Young 2024:1-2. [PMID: 38712631 DOI: 10.1017/s1047951124025083] [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] [Indexed: 05/08/2024]
Abstract
Ebstein anomaly is frequently associated with accessory pathways, including Mahaim atriofascicular fibres. We herein illustrate successful Mahaim fibre ablation in Ebstein anomaly by targeting the ventricular insertion site below the tricuspid ridge.
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Affiliation(s)
| | - Hannes Sallmon
- Division of Pediatric Cardiology, Medical University of Graz, Graz, Austria
| | - Daniel Scherr
- Division of Cardiology, Medical University of Graz, Graz, Austria
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2
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Palmieri V, Yijin X, Fischbach P, Whitehill R. Safety of same-day discharge without anticoagulation for left-sided radiofrequency catheter ablations in pediatrics. Heart Rhythm 2024; 21:592-599. [PMID: 38215810 DOI: 10.1016/j.hrthm.2024.01.004] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND For left-sided radiofrequency catheter ablation (LCA) in pediatrics, significant practice variability exists regarding anticoagulation and discharge practices. Given the lack of data in pediatric patients, the risks and benefits of these practices are not well defined. OBJECTIVE The purpose of this study was to evaluate the safety of same-day discharge and use of aspirin (ASA) in pediatric patients following LCA. METHODS We performed a retrospective cohort study of pediatric patients who underwent LCA from 2010 to 2020 at our institution. Discharge timing and ASA usage were based on operator preference. The primary outcome was incidence of postablation anticoagulation complications reported within 1 month of the procedure. RESULTS Three hundred seventy-six patients underwent LCA and met inclusion criteria. Median [25th, 75th percentiles] age was 13.9 [10.5, 16.2] years; 18 (4.7%) had a history of structural heart disease. The most common substrates for ablation were Wolff-Parkinson-White syndrome (183 patients [48.7%]), concealed accessory pathway (159 patients [42.3%]), and ectopic atrial tachycardia (10 patients [2.7%]). Three hundred thirty-eight patients (89.9%) were discharged on the day of LCA. Seventy-six patients (20.2%) were prescribed ASA at discharge. Of those who underwent follow-up (273 patients [72.6%]), 7 (2.7%) reported an anticoagulation complication (5 with hematoma, 2 with headache). One of these patients was prescribed ASA; none required readmission. There was no correlation between anticoagulation complications and same-day discharge or with ASA usage. CONCLUSION Given the rare incidence of anticoagulation complications in pediatric patients undergoing LCAs, same-day discharge from the electrophysiology laboratory without anticoagulation should be considered.
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Affiliation(s)
- Vincent Palmieri
- Children's Healthcare of Atlanta Cardiology, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia.
| | - Xiang Yijin
- Emory University School of Medicine, Atlanta, Georgia
| | - Peter Fischbach
- Children's Healthcare of Atlanta Cardiology, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia
| | - Robert Whitehill
- Children's Healthcare of Atlanta Cardiology, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia
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3
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Burke BJ, El Assaad I, Liu W, Kanj M, Wazni OM, Callahan TD, Baranowski B, Saarel EV, Heilbronner A, Aziz PF. Underestimated recurrence rates after ablation for Wolff-Parkinson-White syndrome and impact on follow-up practices. Heart Rhythm 2024:S1547-5271(24)02498-6. [PMID: 38663786 DOI: 10.1016/j.hrthm.2024.04.071] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/12/2024] [Accepted: 04/17/2024] [Indexed: 05/14/2024]
Affiliation(s)
- Brendan J Burke
- Department of Pediatric Cardiology and Electrophysiology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Iqbal El Assaad
- Department of Pediatric Cardiology and Electrophysiology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Wei Liu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Mohamed Kanj
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Oussama M Wazni
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Thomas D Callahan
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Bryan Baranowski
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Peter F Aziz
- Department of Pediatric Cardiology and Electrophysiology, Cleveland Clinic Children's, Cleveland, Ohio.
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Brešković T, Lisica L, Jurišić Z, Petrović D, Sikirić I, Metličić V, Anić A. Ablation of accessory pathways in different anatomic locations using focal pulsed field ablation. Heart Rhythm 2024:S1547-5271(24)00275-3. [PMID: 38499129 DOI: 10.1016/j.hrthm.2024.03.030] [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: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Ablation of accessory pathways (APs) is the cornerstone for treatment of patients with Wolff-Parkinson-White syndrome and manifestation of atrioventricular reentrant tachycardia. Pulsed field ablation (PFA) is a new type of nonthermal energy source delivered to the underlying tissue via the ablation catheter and used for ablation of arrhythmic substrates. OBJECTIVE The purpose of this study was to determine the efficiency and long-term outcome of ablation of APs of different localizations using a focal pulsed electrical field. METHODS Electrophysiological study was performed in patients with indication for AP ablation. An ablation catheter was used to map the position of AP insertion. Pulsed electric field was delivered through a standard ablation catheter. In left-sided APs, the first ablation attempt was within the coronary sinus (CS). Patient follow-up was scheduled 1-3 months after the ablation. Additional check-up was performed after 6 and 12 months. RESULTS Fourteen 14 patients (3 pediatric) were treated. Termination of AP conduction was achieved in all procedures. The cohort consisted of 3 right free wall, 3 posteroseptal, and 8 left-sided APs. Ablation through CS was successfully used in 7 of 8 patients with left-sided APs. No complications were reported. Median follow-up was 5.5 months. Conduction recurrence through AP was documented in 1 patient. CONCLUSION Focal PFA for AP shows promising results in terms of efficacy and safety. A high rate of successful termination of left-sided APs by ablation within CS may represent a new standard approach. The safety and efficacy profile of PFA seems to be transferable to the pediatric population.
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Affiliation(s)
- Toni Brešković
- Department of Cardiology, University Hospital Center Split, Split, Croatia.
| | - Lucija Lisica
- Department of Cardiology, University Hospital Center Split, Split, Croatia
| | - Zrinka Jurišić
- Department of Cardiology, University Hospital Center Split, Split, Croatia
| | - Davor Petrović
- Division of Cardiology, Department of Pediatrics, University Hospital Center Split, Split, Croatia
| | - Ivan Sikirić
- Department of Cardiology, University Hospital Center Split, Split, Croatia
| | - Vitomir Metličić
- Division of Cardiology, Department of Pediatrics, University Hospital Center Split, Split, Croatia
| | - Ante Anić
- Department of Cardiology, University Hospital Center Split, Split, Croatia
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5
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Rudic B, Borggrefe M. [Historical developments in the diagnosis and treatment of pre-excitation syndromes (WPW)]. Herzschrittmacherther Elektrophysiol 2024; 35:118-126. [PMID: 38427036 PMCID: PMC10923739 DOI: 10.1007/s00399-024-01000-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
In 1930, Wolff, Parkinson and White described the syndrome that bears their names. The mechanisms of supraventricular tachycardias were analyzed by brilliant electrocardiography interpretation by Pick and Langendorf. Wellens and Durrer using electrophysiologic studies analyzed the tachycardia mechanism invasively. In Germany the group by Seipel and Breithardt as well as Neuss and Schlepper studied the tachycardia mechanisms and response to antiarrhythmic drugs invasively by electrophysiological studies. Following the first successful interruption of an accessory pathway by Sealy in 1967, surgeons and electrophysiologists cooperated in Germany. Two centers, Hannover and Düsseldorf were established. Direct current (DC) ablation of accessory pathways was introduced by Morady and Scheinman. Because of side effects induced by barotrauma of DC, alternative strategies were studied. In 1987, radiofrequency ablation was introduced and thereafter established as curative therapy of accessory pathways in all locations.
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Affiliation(s)
- Boris Rudic
- I. Medizinische Klinik, Universitätsmedizin Mannheim, 68167, Mannheim, Theodor-Kutzer-Ufer 1-3, Deutschland.
| | - Martin Borggrefe
- I. Medizinische Klinik, Universitätsmedizin Mannheim, 68167, Mannheim, Theodor-Kutzer-Ufer 1-3, Deutschland.
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Okada M, Mizutani A, Tanaka K, Tanaka N. Delineating multiple septal accessory pathways using open-window mapping with a novel multi-spline mapping catheter. HeartRhythm Case Rep 2024; 10:238-240. [PMID: 38496732 PMCID: PMC10943530 DOI: 10.1016/j.hrcr.2023.12.010] [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: 03/19/2024] Open
Affiliation(s)
- Masato Okada
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Akinobu Mizutani
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Koji Tanaka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Nobuaki Tanaka
- Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan
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7
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Umapathi KK, Nayak HM, Kohli U. Wide QRS tachycardia: What is the mechanism? Pacing Clin Electrophysiol 2024; 47:401-405. [PMID: 38341632 DOI: 10.1111/pace.14949] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/13/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Krishna Kishore Umapathi
- Division of Pediatric Cardiology, Department of Pediatrics, Charleston Area Medical Center, Charleston, West Virginia, USA
| | - Hemal M Nayak
- Division of Cardiology, University of Texas Health, San Antonio, Texas, USA
| | - Utkarsh Kohli
- Division of Pediatric Cardiology, Department of Pediatrics, West Virginia University School of Medicine and West Virginia University Children's Heart Center, Morgantown, West Virginia, USA
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Klein HU, Trappe HJ, Frank G. [History of surgical treatment of cardiac arrhythmias in Germany : Surgical treatment of ventricular tachycardia and supraventricular tachycardia, especially pre-excitation syndromes (WPW)]. Herzschrittmacherther Elektrophysiol 2024; 35:88-97. [PMID: 38416160 PMCID: PMC10923999 DOI: 10.1007/s00399-024-01012-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 02/29/2024]
Abstract
The history of surgical treatment of ventricular tachycardias (VT) is short, lasting from 1978 until 1993. "Indirect procedures" with infarct scar resection were performed without electrophysiologic studies, whereas "direct procedures" consisted of either complete endocardial incisions ("encircling endocardial ventriculotomy") or large endocardial resections ("endocardial peel-off" technique) after precise epicardial and endocardial mapping procedures. In Germany, the first to report on intra-operative electrophysiologic mapping for VT treatment were Ostermeyer, Breithardt and Seipel in 1979. In 1981, the Hannover group (Frank, Klein) published their first results of surgical treatment of VT. In 1984, Ostermeyer et al. demonstrated that a partial endocardial incision resulted in more beneficial results with less myocardial damage (8% versus 46%) than applying a complete encircling incision. In 1987, the Düsseldorf group reported treatment results of 93 patients. After 5 years, 77% had no VT recurrence, while total mortality after 1 year was 11% and after 5 years 30%. In 1992, the Hannover group reported results of 147 patients after endocardial resection for VT. Total mortality after 3 years was 27%; recurrence of VT events occurred in 18% of the surviving cohort.The history of surgical procedures for supraventricular tachycardia (SVT), in particular Wolff-Parkinson-White (WPW) syndrome, is even shorter than that of surgery for VT. As early as 1969, Sealy, Gallagher and Cox reported the first cases of surgical intervention for WPW syndrome via endocardial access in cardioplegic arrest. In 1984, Guiraudon and Klein reported on a new procedure with epicardial access to the accessory bundle without cardioplegia in laterally localised conduction pathways. In Germany, too, the groups in Düsseldorf (Ostermeyer, Seipel, Breithardt, Borggrefe) from 1980 and the Hannover group (Frank, Klein and Kallfelz) from 1981 performed surgical procedures for WPW syndrome. In 1987, Borggrefe reported on 18 patients with WPW syndrome and atrial fibrillation who had undergone surgery. After 2 years, 14 of 18 patients had no recurrences of tachycardia; in 1989, Frank, Klein and Kallfelz (Hannover) reported on 10 children (2-14 years) operated on using the cryoablation technique. Between 1984 and 1992, a total of 120 patients with SVT, mostly WPW syndrome, were operated on in Hannover; after 42 months, 12 patients had a recurrence of SVT. Two patients died during the reoperation.
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Radhakrishnan SL, Drutel RO, Williams CM, Danrad R, Gajewski KK, LeLorier PA. Ablation of accessory pathway from right atrial appendage to anatomic left ventricle in L-transposition of the great arteries. HeartRhythm Case Rep 2024; 10:175-179. [PMID: 38496736 PMCID: PMC10943528 DOI: 10.1016/j.hrcr.2023.12.003] [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: 03/19/2024] Open
Affiliation(s)
| | - Robert O. Drutel
- Louisiana State University Health Sciences Center – New Orleans, New Orleans, Louisiana
| | - Cody M. Williams
- Louisiana State University Health Sciences Center – New Orleans, New Orleans, Louisiana
| | - Raman Danrad
- Louisiana State University Health Sciences Center – New Orleans, New Orleans, Louisiana
| | - Kelly K. Gajewski
- Louisiana State University Health Sciences Center – New Orleans, New Orleans, Louisiana
| | - Paul A. LeLorier
- Louisiana State University Health Sciences Center – New Orleans, New Orleans, Louisiana
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10
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Klein HU, Trappe HJ, Frank G. [Short history of the DC-Catheter-Ablation]. Herzschrittmacherther Elektrophysiol 2024; 35:98-101. [PMID: 38421400 PMCID: PMC10923988 DOI: 10.1007/s00399-024-01011-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
Direct current (DC) catheter ablation in 5 patients aiming to interrupt rapid atrioventricular (AV) conduction with atrial fibrillation and subsequent pacemaker implantation was first published by M. M. Scheinman et al. (San Francisco, CA, USA) in 1982. In Germany, L. Seipel, G. Breithardt, and M. Borggrefe reported their first experience with DC catheter ablation in 1984, followed by the group in Bonn (M. Manz and B. Lüderitz) in 1985. The first international DC catheter ablation registry, which also included four German centers, reported DC catheter ablation results of 127 patients in 24 centers in 1984. Complete AV block was achieved in 71% patients. In 1992, the Hannover group (H‑J. Trappe, H. Klein and J. Huang) reported results of DC catheter ablation of AV conduction performed between 1983 and 1990 in 100 patients (86% with rapid atrial fibrillation, 14% with AV-node reentry tachycardias). The first successful DC catheter ablation in a patient with Wolff-Parkinson-White (WPW) syndrome was reported in 1985 by F. Morady et al. (San Francisco, CA, USA). In 1987, M. Borggrefe et al. were the first to report a switch from DC catheter ablation to a high-frequency (HF) catheter ablation procedure in a patient with WPW syndrome. The use of DC catheter ablation to treat ventricular tachycardia (VT) was described by G. O. Hartzler (Kansas City, MO, USA) in 3 patients in 1983. M. Borggrefe et al. (1989) reported on 24 patients who underwent DC catheter ablation for VT. Of those, 17 patients did not have VT recurrence within the following 14 months. In 1994, the Hannover group (H-J Trappe, H. Klein) published their 5‑year long-term results of DC catheter ablation of VT in 51 patients. VT recurrence occurred in 57% patients and overall mortality was also high (16%). A comparison of DC catheter ablation with HF catheter ablation for recurrent VT was reported in 1994 by G. Gonska et al. (Göttingen, Germany). After 2 years follow-up, success rates were not found to be significantly different.
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Saito A, Mochida C, Mizuno A, Masuda K. Utility of Intracoronary Acetylcholine Provocation Testing in Inducing Atrial Fibrillation with Preexcitation Followed by Ventricular Fibrillation in a Patient with Wolff-Parkinson-White Syndrome: A Case Report. Intern Med 2024:3000-23. [PMID: 38369356 DOI: 10.2169/internalmedicine.3000-23] [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] [Indexed: 02/20/2024] Open
Abstract
A 20-year-old man was resuscitated after ventricular fibrillation (VF). Electrocardiography revealed Wolff-Parkinson-White (WPW) syndrome. Intracoronary acetylcholine provocation testing was performed to induce VF secondary to the coronary vasospasm. The administration of acetylcholine to the coronary artery induced atrial fibrillation (AF) with pre-excitation, followed by VF without coronary vasospasm. Electrophysiological studies revealed an accessory pathway managed by catheter ablation. Subsequent intracoronary acetylcholine provocation testing (ACH test) induced the occurrence of AF without preexcitation. To our knowledge, this case report is the first to demonstrate the utility of the ACH test in confirming WPW syndrome as a cause of VF.
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Affiliation(s)
- Akira Saito
- Department of Cardiology, St Luke's International University, Japan
| | - Chisaki Mochida
- Department of Cardiology, St Luke's International University, Japan
| | - Atsushi Mizuno
- Department of Cardiology, St Luke's International University, Japan
| | - Keita Masuda
- Department of Cardiology, St Luke's International University, Japan
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Nakatani Y, Take Y, Yoshimura S, Nakamura K, Naito S. Dual-chamber open-window mapping for an epicardial accessory pathway through the posterior coronary vein. HeartRhythm Case Rep 2024; 10:162-165. [PMID: 38404972 PMCID: PMC10885715 DOI: 10.1016/j.hrcr.2023.11.011] [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: 02/27/2024] Open
Affiliation(s)
- Yosuke Nakatani
- Division of Non-pharmacological Management of Cardiac Arrhythmias, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yutaka Take
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | - Shingo Yoshimura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | - Kohki Nakamura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
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13
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Tri J, Sriram A, Asirvatham SJ. An accessory for pathway ablation. Indian Pacing Electrophysiol J 2024; 24:6-8. [PMID: 38237667 PMCID: PMC10927972 DOI: 10.1016/j.ipej.2024.01.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024] Open
Affiliation(s)
- Jason Tri
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, USA
| | | | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, USA; Department of Pediatrics and Adolescent Medicine, USA; Department of Biomedical Engineering, USA; Department of Clinical Anatomy, Mayo Clinic, Rochester, MN, USA.
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14
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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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Alken FA, Scherschel K, Zhu E, Kahle AK, Meyer C. [Long-term results of catheter ablation for AV nodal reentry tachycardias and accessory pathways]. Herzschrittmacherther Elektrophysiol 2023; 34:278-285. [PMID: 37861731 DOI: 10.1007/s00399-023-00965-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023]
Abstract
Atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia in patients with accessory pathways (AP) are common supraventricular tachycardias. High long-term efficacy of about 97% (AVNRT) and 92% (AP) has been observed in children and adults. The risk of occurring atrioventricular block is low (0.4-0.8% during AVNRT, 0.1-0.2% for AP). Catheter ablation shows a lower efficacy of 87-93% and elevated atrioventricular block risk up to 10% in patient groups with complex congenital heart disease. Nonsynchronized ventricular activation during preexcitation or permanent reentrant tachycardias can induce heart failure, and remission of left ventricular function can be expected in > 90% after successful catheter ablation. Therefore, catheter ablation is the long-term therapy of choice for AVNRT and AP with high efficacy and safety for most patient populations.
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Affiliation(s)
- Fares-Alexander Alken
- Klinik für Kardiologie/Angiologie/Intensivmedizin, cNEP, cardiac Neuro- and Electrophysiology research group, Evangelisches Krankenhaus Düsseldorf, Kirchfeldstraße 40, 40217, Düsseldorf, Deutschland
| | - Katharina Scherschel
- Klinik für Kardiologie/Angiologie/Intensivmedizin, cNEP, cardiac Neuro- and Electrophysiology research group, Evangelisches Krankenhaus Düsseldorf, Kirchfeldstraße 40, 40217, Düsseldorf, Deutschland
- Institut für Neuro- und Sinnesphysiologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Deutschland
| | - Ernan Zhu
- Klinik für Kardiologie/Angiologie/Intensivmedizin, cNEP, cardiac Neuro- and Electrophysiology research group, Evangelisches Krankenhaus Düsseldorf, Kirchfeldstraße 40, 40217, Düsseldorf, Deutschland
| | - Ann-Kathrin Kahle
- Klinik für Kardiologie/Angiologie/Intensivmedizin, cNEP, cardiac Neuro- and Electrophysiology research group, Evangelisches Krankenhaus Düsseldorf, Kirchfeldstraße 40, 40217, Düsseldorf, Deutschland
- Klinik für Kardiologie, Pneumologie und Angiologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - Christian Meyer
- Klinik für Kardiologie/Angiologie/Intensivmedizin, cNEP, cardiac Neuro- and Electrophysiology research group, Evangelisches Krankenhaus Düsseldorf, Kirchfeldstraße 40, 40217, Düsseldorf, Deutschland.
- Institut für Neuro- und Sinnesphysiologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Deutschland.
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Kantharia BK, Shah AN. Open-window mapping for ablation of Wolff-Parkinson-White syndrome related hemodynamically unstable tachycardia. Pacing Clin Electrophysiol 2023; 46:1599-1603. [PMID: 36951473 DOI: 10.1111/pace.14693] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 10/25/2022] [Revised: 12/16/2022] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
During catheter ablation (CA) of tachycardia, conventional point-by-point mapping may be hindered due to hemodynamic instability. We performed open-window mapping (CARTO, Biosense Webster, USA) in a patient who developed hemodynamic instability during orthodromic atrioventricular reciprocating tachycardia (AVRT) and unwarranted induction of AVRT during attempts to map accessory pathway (AP) with ventricular pacing. With over 11,000 points acquired rapidly, the system accurately identified AP at the mitral valve (MV) annulus where the application of single radiofrequency (RF) lesion promptly eliminated AP's conduction. Our case illustrates the utility of open-window mapping for the ablation of AVRT.
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Affiliation(s)
- Bharat K Kantharia
- Cardiovascular and Heart Rhythm Consultants, New York, New York, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Arti N Shah
- Cardiovascular and Heart Rhythm Consultants, New York, New York, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- NYC Health and Hospitals, Elmhurst, Queens, New York, USA
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Torun EG, Koca S, Dinçel GK, Çay S. Successful catheter ablation of the accessory pathway in an unusual location in a 13-year-old girl with a coronary sinus diverticulum and Wolff-Parkinson-White syndrome. Cardiol Young 2023; 33:2375-2378. [PMID: 37144400 DOI: 10.1017/s1047951123001117] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Wolff-Parkinson-White syndrome is a congenital cardiac pre-excitation syndrome that is effectively treated by ablating the accessory pathway. However, accessory pathways located in the posteroseptal region can sometimes be challenging. In this paper, we present the successful ablation of the epicardial posteroseptal accessory pathway through the middle cardiac vein in a 13-year-old girl with a coronary sinus diverticulum and Wolff-Parkinson-White syndrome, after unsuccessful ablation attempts at different locations. If the ablation procedure fails, the possibility of the posteroseptal pathway should be kept in mind, and coronary sinus angiography should be performed. In cases with a coronary sinus diverticulum where ablation is not successful, other coronary sinus structures, for example, the middle cardiac vein should be considered as potential accessory pathways.
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Affiliation(s)
- Emine Gulsah Torun
- Department of Pediatric Cardiology, Ankara City Hospital, Ankara, Turkey
| | - Serhat Koca
- Department of Pediatric Cardiology, Ankara City Hospital, Ankara, Turkey
| | - Gökçe Kaya Dinçel
- Department of Pediatric Cardiology, Ankara City Hospital, Ankara, Turkey
| | - Serkan Çay
- Department of Cardiology, Division of Arrhythmia and Electrophysiology, Ankara City Hospital, Ankara, Turkey
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18
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Xiong N, Gu W, Li J, Scheinman MM. A tortuous tale of tachycardia termination. Heart Rhythm 2023; 20:1457-1458. [PMID: 37777304 DOI: 10.1016/j.hrthm.2022.11.021] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 10/02/2023]
Affiliation(s)
- Nanqing Xiong
- Department of Cardiology, Huashan Hospital Fudan University, Shanghai, China
| | - Wentao Gu
- Department of Cardiology, Huashan Hospital Fudan University, Shanghai, China
| | - Jian Li
- Department of Cardiology, Huashan Hospital Fudan University, Shanghai, China
| | - Melvin M Scheinman
- Division of Electrophysiology, Department of Cardiology, University of California San Francisco, San Francisco, California.
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19
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Robles AG, Palamà Z, Pernat A, Gianfrancesco D, Bartolomucci F, Scarà A, Borrelli A, De Ruvo E, Calò L, Penco M, Romano S, Sciarra L. Intermittent ventricular pre-excitation in symptomatic adults: Always a marker of low risk? Pacing Clin Electrophysiol 2023; 46:1049-1055. [PMID: 37527153 DOI: 10.1111/pace.14798] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/25/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Intermittent ventricular pre-excitation was considered a low-risk marker for sudden death. However, to date, some studies do not exclude the existence of accessory pathways (APs) with high-risk intermittent antegrade conductive properties. According to current European Guidelines, high-risk features of APs are antegrade pathway conduction ≤250 ms in baseline or during the adrenergic stimulus, inducibility of atrioventricular reciprocating tachycardias (AVRT), inducibility of pre-excited atrial fibrillation (AF), and presence of multiple APs. For all of these transcatheter ablation is recommended. The aim of our study was to evaluate the existence of differences in risk characteristics between patients with intermittent pre-excitation (IPX) and those with persistent pre-excitation (PPX), from a sample of adults with ventricular pre-excitation and symptoms like palpitations. METHODS 293 adults [IPX: 51 (17.4%); PPX: 242 (82.6%)] underwent electrophysiological study and then catheter ablation of their APs if arrhythmia inducibility (AVRT/AF) was noted, or, conversely, if it was appreciated a fast AP antegrade conduction, in baseline or during intravenous isoproterenol infusion, or if multiple APs were detected. RESULTS There were no statistically significant differences in demographic characteristics (age and gender), AVRT/AF inducibility, antegrade conductive properties, the prevalence of multiple APs, and APs locations between IPX and PPX patients. CONCLUSIONS In our study, patients with IPX did not show significant differences in clinical and electrophysiological features versus PPX patients.
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Affiliation(s)
- Antonio Gianluca Robles
- Department of Clinical Medicine, Public Health, Life and Environmental Science, University of L'Aquila, L'Aquila, Italy
- Cardiology Unit, "L. Bonomo" Hospital, Andria, Italy
| | - Zefferino Palamà
- Department of Clinical Medicine, Public Health, Life and Environmental Science, University of L'Aquila, L'Aquila, Italy
- Villa Verde C.D.C. Health Centre, Taranto, Italy
| | - Andrej Pernat
- Arrhythmology Unit, University Medical Center Ljubljana (UMCL), Ljubljana, Slovenia
| | | | | | - Antonio Scarà
- Arrhythmology, Hospital San Carlo di Nancy, Rome, Italy
| | | | | | | | - Maria Penco
- Department of Clinical Medicine, Public Health, Life and Environmental Science, University of L'Aquila, L'Aquila, Italy
| | - Silvio Romano
- Department of Clinical Medicine, Public Health, Life and Environmental Science, University of L'Aquila, L'Aquila, Italy
| | - Luigi Sciarra
- Department of Clinical Medicine, Public Health, Life and Environmental Science, University of L'Aquila, L'Aquila, Italy
- Arrhythmology, Hospital San Carlo di Nancy, Rome, Italy
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20
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Przybylski R, DeWitt ES, Meziab O, Gauvreau K, Dionne A, O'Leary ET, Alexander ME, Walsh EP, Mah DY. Retroflexed catheter course reduces the risk of right free wall accessory pathway recurrence. J Cardiovasc Electrophysiol 2023; 34:1828-1834. [PMID: 37449445 DOI: 10.1111/jce.16003] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/18/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Accessory atrioventricular pathways (APs) may mediate atrioventricular reciprocating tachycardia and, in some cases, have the potential to conduct atrial tachycardia rapidly, which can be life threatening. While catheter ablation can be curative, ablation of right free wall APs is associated with a high rate of recurrence, likely secondary to reduced catheter stability along the right free wall atrioventricular groove. We sought to identify characteristics associated with a lower rate of recurrence and hypothesized ablation lesions placed on the ventricular side of the atrioventricular groove using a retroflexed catheter approach would decrease rates of recurrence. METHODS AND RESULTS Retrospective chart review of patients who underwent catheter ablation of a right free wall AP from January 1, 2008 through June 1, 2021 with >2 months follow up. Cox proportional hazards regression was used to identify relationships between predictor variables and AP recurrence. We identified 95 patients who underwent ablation of 98 right free wall APs. Median age was 13.1 years and median weight at ablation was 52.3 kg. Overall, 23/98 (23%) APs recurred. Use of a retroflexed catheter course approaching the atrioventricular groove from the ventricular aspect was associated with reduced risk of AP recurrence with (univariable hazard ratio of 0.10 [95% confidence interval: 0.01-0.78]), which remained significant in multiple two variable Cox proportional hazards models. CONCLUSION Use of a retroflexed catheter course is associated with a reduced likelihood of AP recurrence. This approach results in improved catheter stability and should be considered for ablation of right free wall APs.
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Affiliation(s)
- Robert Przybylski
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth S DeWitt
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Omar Meziab
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Audrey Dionne
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Edward T O'Leary
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark E Alexander
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Edward P Walsh
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Douglas Y Mah
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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21
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Yagishita A, Yamauchi Y, Sagawa Y, Lee KH, Sakama S, Ayabe K, Amino M, Ikari Y, Yoshioka K. Utility of open-window mapping for catheter ablation of an accessory pathway in patients with Wolff-Parkinson-White syndrome. Pacing Clin Electrophysiol 2023; 46:882-889. [PMID: 37493225 DOI: 10.1111/pace.14795] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Open-window mapping (OWM) is a novel automated mapping method for catheter ablation of an accessory pathway (AP), in which the local signal is annotated with window-of-interest parameters to analyze both atrial and ventricular signals. This study aimed to determine the utility of OWM in visualizing the location and width of APs in patients with Wolff-Parkinson-White syndrome. METHODS This two-center study enrolled 30 patients (20 males; mean age: 56 years, interquartile range [IQR]: 22-69 years) who underwent high-density OWM with the extended early-meets-late (EEML) algorithm using a 20-electrode, 5-spline catheter (PENTARAY, Biosense Webster). The lower threshold of the EEML was set to adjust the EEML gap to match the propagation mapping, and broad APs were defined as an EEML gap > 1 cm. RESULTS The median mapping points, mapping time, and lower threshold of the EEML were 2482 (IQR: 1755-4000) points, 23 (IQR: 15-30) min, and 23 (IQR: 18-25), respectively. All 30 APs (24 in the mitral annulus and 6 in the tricuspid annulus) were successfully eliminated. Of these APs, 21 (70%) were eliminated by the first radio frequency (RF) application. OWM revealed broad APs in 11 patients (37%), in four of whom (36%) the first RF application achieved a loss of AP conduction (vs. 90% of patients without broad APs; p = .004). CONCLUSION OWM facilitates the visualization of the location and width of APs, which may be particularly useful for predicting whether multiple RF applications are required for broad APs.
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Affiliation(s)
| | - Yasuteru Yamauchi
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Kanagawa, Japan
| | - Yuichiro Sagawa
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Kanagawa, Japan
| | - Kyong Hee Lee
- Department of Cardiology, Tokai University, Kanagawa, Japan
| | - Susumu Sakama
- Department of Cardiology, Tokai University, Kanagawa, Japan
| | - Kengo Ayabe
- Department of Cardiology, Tokai University, Kanagawa, Japan
| | - Mari Amino
- Department of Cardiology, Tokai University, Kanagawa, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University, Kanagawa, Japan
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22
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Diallo TH, Faraj R, Hilal S, Lahraoui M, Kisra O, Benmessaoud FA, Doghmi N, Fellat I, Cherti M. Pre-excited atrial fibrillation revealed at a very delayed age: case report. Int J Emerg Med 2023; 16:34. [PMID: 37170212 PMCID: PMC10173537 DOI: 10.1186/s12245-023-00506-z] [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: 02/27/2023] [Accepted: 05/03/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Wolff-Parkinson-White (WPW) syndrome is a condition characterized by the persistence of an accessory pathway responsible for ventricular pre-excitation that can lead to symptomatic and potentially severe arrhythmias. Coexistence with atrial fibrillation is well known and not uncommon, exposing to potential degenerescence into ventricular fibrillation when atrial impulses are transmitted along the accessory pathway. WPW syndrome is most prevalent in younger patients and cases revealed after an advanced age have rarely been described in the literature. CASE PRESENTATION Here, we report a case of atrial pre-excitation first diagnosed at the age of 72 years that required external electrical cardioversion with a favorable outcome. The diagnosis was based on clinical and electrographic findings. CONCLUSIONS WPW syndrome is a relatively rare cardiac disorder that can be a cause of sudden death, especially when combined with atrial fibrillation. Therefore, cardiologists have to consider this diagnosis in patients presenting clinical signs of arrhythmia with an electrical pattern of WPW.
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Affiliation(s)
- Thierno Hamidou Diallo
- Clinical cardiology department, Cardiology Center, Mohammed V Military Instruction Hospital of Rabat, Mohammed V University, Rabat, Morocco
| | - Raid Faraj
- Cardiology B department, Ibn Sina University Hospital of Rabat, Mohammed V University, Rabat, Morocco.
| | - Safae Hilal
- Cardiology B department, Ibn Sina University Hospital of Rabat, Mohammed V University, Rabat, Morocco
| | - Myriam Lahraoui
- Cardiology B department, Ibn Sina University Hospital of Rabat, Mohammed V University, Rabat, Morocco
| | - Oualid Kisra
- Cardiology B department, Ibn Sina University Hospital of Rabat, Mohammed V University, Rabat, Morocco
| | | | - Nawal Doghmi
- Cardiology B department, Ibn Sina University Hospital of Rabat, Mohammed V University, Rabat, Morocco
| | - Ibtissam Fellat
- Cardiology B department, Ibn Sina University Hospital of Rabat, Mohammed V University, Rabat, Morocco
| | - Mohamed Cherti
- Cardiology B department, Ibn Sina University Hospital of Rabat, Mohammed V University, Rabat, Morocco
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23
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Etheridge SP, Gakenheimer-Smith L, Asaki SY, Niu M. Asymptomatic Wolff-Parkinson-White Syndrome: An Ounce of Prevention Is Worth the Risk of Cure. Curr Cardiol Rep 2023; 25:543-551. [PMID: 37115433 DOI: 10.1007/s11886-023-01879-6] [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] [Accepted: 04/04/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE OF REVIEW With increased electrocardiogram screening, asymptomatic preexcitation has become more prevalent. Historically, the asymptomatic-symptomatic dichotomy has directed management. This approach warrants scrutiny, as asymptomatic Wolff-Parkinson-White (WPW) syndrome is not without risk. Children may be unreliable symptom reporters, have atypical arrhythmia symptoms, yet have years to become symptomatic. RECENT FINDINGS In a large WPW study, symptomatic patients were more likely to undergo ablation than asymptomatic patients, yet, except for symptoms, there were no differences in clinical or electrophysiology study (EPS) characteristics. Present data confirm real risk in asymptomatic WPW-sudden death can be the first symptom. Although malignant arrhythmias correlate better with EPS risk stratification than with symptoms, EPS data are imperfect predictors. Unlike adults with WPW, children have yet to prove survivorship. Asymptomatic children must be treated differently than adults. Sudden death risk is low but front-loaded in the young. An aggressive approach to asymptomatic WPW is warranted in this era of highly successful, low-risk catheter ablations.
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Affiliation(s)
- Susan P Etheridge
- Primary Children's Hospital, The University of Utah, 84112, Salt Lake City, UT, USA.
| | | | - S Yukiko Asaki
- Primary Children's Hospital, The University of Utah, 84112, Salt Lake City, UT, USA
| | - Mary Niu
- Primary Children's Hospital, The University of Utah, 84112, Salt Lake City, UT, USA
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24
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Sidler M, Santarelli G, Kovacevic A, Novo Matos J, Schreiber N, Baron Toaldo M. Ventricular pre-excitation in cats: 17 cases. J Vet Cardiol 2023; 47:70-82. [PMID: 37267820 DOI: 10.1016/j.jvc.2023.04.005] [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: 07/07/2022] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Atrioventricular accessory pathways are abnormal electrical connections between the atria and ventricles that predispose to ventricular pre-excitation (VPE) and tachycardias. ANIMALS Seventeen cats with VPE and 15 healthy matched-control cats. MATERIAL AND METHODS Multicenter case-control retrospective study. Clinical records were searched for cats with VPE, defined as preserved atrioventricular synchrony, reduced PQ interval, and increased QRS complex duration with a delta wave. Clinical, electrocardiography, echocardiographic, and outcome data were collated. RESULTS Most cats with VPE were male (16/17 cats), non-pedigree cats (11/17 cats). Median age and mean body weight were 5.4 years (0.3-11.9 years) and 4.6 ± 0.8 kg, respectively. Clinical signs at presentation included lethargy (10/17 cats), tachypnea (6/17 cats), and/or syncope (3/17 cats). In two cats, VPE was an incidental finding. Congestive heart failure was uncommon (3/17 cats). Nine (9/17) cats had tachyarrhythmias: 7/9 cats had narrow QRS complex tachycardia and 2/9 cats had wide QRS complex tachycardia. Four cats had ventricular arrhythmias. Cats with VPE had larger left (P < 0.001) and right (P < 0.001) atria and thicker interventricular septum (P = 0.019) and left ventricular free wall (P = 0.028) than controls. Three cats had hypertrophic cardiomyopathy. Treatment included different combinations of sotalol (5/17 cats), diltiazem (5/17 cats), atenolol (4/17 cats), furosemide (4/17 cats), and platelet inhibitors (4/17 cats). Five cats died, all from cardiac death (median survival time 1882 days [2-1882 days]). CONCLUSIONS Cats with VPE had a relatively long survival, albeit showing larger atria and thicker left ventricular walls than healthy cats.
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Affiliation(s)
- M Sidler
- Division of Cardiology, Clinic for Small Animal Medicine, Vetsuisse Faculty, University of Zurich, Switzerland
| | - G Santarelli
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Utrecht, the Netherlands
| | - A Kovacevic
- Division of Small Animal Cardiology, Department of Veterinary Clinical Medicine, Vetsuisse Faculty, University of Bern, Switzerland
| | - J Novo Matos
- Queen's Veterinary School Hospital, Department of Veterinary Medicine, University of Cambridge, UK
| | - N Schreiber
- Division of Cardiology, Clinic for Small Animal Medicine, Vetsuisse Faculty, University of Zurich, Switzerland
| | - M Baron Toaldo
- Division of Cardiology, Clinic for Small Animal Medicine, Vetsuisse Faculty, University of Zurich, Switzerland.
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25
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Zhang Z, Ma C, Li X, Qu L, Zhao B, Bai R. Successful ablation of a right epicardial accessory pathway via the right ventricular diverticulum in a patient with Wolff-Parkinson-White syndrome. J Cardiovasc Electrophysiol 2023; 34:1302-1304. [PMID: 37003264 DOI: 10.1111/jce.15899] [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: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION We describe one rare case of successful ablation of a right epicardial accessory pathway (AP) via the right ventricular diverticulum in a patient with Wolff-Parkinson-White syndrome. METHODS A 42-year-old woman being referred to the hospital for a catheter ablation of a Wolf-Parkinson White syndrome. Earliest activation was shown to be present in the region of the tricuspid annulus. However, ablation had no effect on the AP. RESULTS We decided to do a selected angiography, in which a big diverticulum near to the right tricuspid annulus was shown to be present. Ablation in this region successfully repressed the AP without any recurrences within a follow-up period of 12 months. CONCLUSTION The ventricular diverticulum mediated AP is a novel variant of pre-excitation. It can serve as an anatomical substrate of supraventricular tachycardia, and can be ablated endocardially using an irrigation tip catheter within the diverticulum. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Zhijun Zhang
- Department of Cardiology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
| | - Changsheng Ma
- Cardiovascular Division, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Xuewen Li
- Department of Cardiology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
| | - Lijuan Qu
- Department of Cardiology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
| | - Bingye Zhao
- Department of Cardiology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
| | - Rong Bai
- Banner University Medical Center, Phoenix, The University of Arizona College of Medicine, Phoenix, AZ, USA
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26
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Kleemann T. [Supraventricular tachycardia]. Herz 2023; 48:72-86. [PMID: 36692515 DOI: 10.1007/s00059-022-05153-3] [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] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 01/25/2023]
Abstract
Supraventricular tachycardia is a common occurrence in routine clinical practice. As a physician, one can encounter them everywhere, whether as a general practitioner or as an emergency doctor in a hospital. Some tachycardias might have robbed an on-call doctor the night or the last nerve; however, supraventricular tachycardia is usually a benign condition that is easily treatable and, in many cases, even curable. This article covers the differential diagnoses of supraventricular tachycardia and its treatment options. Atrial fibrillation, also a supraventricular tachycardia, is not discussed in this article.
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Affiliation(s)
- Thomas Kleemann
- Medizinische Klinik B, Klinikum Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen, Deutschland.
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27
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Capocci S, Rubino F, Setti M, Butturini C, Tomasi L, Bolzan B, Piccoli A, Ribichini FL, Mugnai G. Wolff-Parkinson-White syndrome and dilated cardiomyopathy: Not only an electrical issue? J Electrocardiol 2023; 78:21-4. [PMID: 36731165 DOI: 10.1016/j.jelectrocard.2023.01.011] [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] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 02/03/2023]
Abstract
The present case describes a dilated cardiomyopathy associated with both antidromic and orthodromic atrio-ventricular reentrant tachycardias supported by multiple right accessory pathways. Both right accessory pathways were successfully eliminated by catheter ablation and the patient progressively recovered during the follow up. The following etiologies might be involved: 1) primitive dilated cardiomyopathy (or post-inflammatory); 2) septal dyssinchrony due to ventricular pre-excitation; 3) tachycardiomyopathy.
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28
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Gómez-Flores J, Cueva-Parra Á, Gallegos-Cortéz A, Nava S, Márquez MF, Iturralde-Torres P. Validation of qrs-polarity algorithm with special emphasis in parahisian pathways. Arch Cardiol Mex 2023; 93:164-171. [PMID: 37054739 PMCID: PMC10161820 DOI: 10.24875/acm.22000090] [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] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND In 1996 Iturralde et al. published an algorithm based on the QRS polarity to determine the location of the accessory pathways (AP), this algorithm was developed before the massive practice of invasive electrophysiology. PURPOSE To validate the QRS-Polarity algorithm in a modern cohort of subjects submitted to radiofrequency catheter ablation (RFCA). Our objective was to determinate its global accuracy and its accuracy for parahisian AP. METHODS We conducted a retrospective analysis of patients with Wolff-Parkinson-White (WPW) syndrome who underwent an electrophysiological study (EPS) and RFCA. We employed the QRS-Polarity algorithm to predict the AP anatomical location and we compared this result with the real anatomic location determined in the EPS. To determine accuracy, the Cohen's kappa coefficient (k) and the Pearson correlation coefficient were used. RESULTS A total of 364 patients were included (mean age 30 years, 57% male). The global k score was 0.78 and the Pearson's coefficient was 0.90. The accuracy for each zone was also evaluated, the best correlation was for the left lateral AP (k of 0.97). There were 26 patients with a parahisian AP, who showed a great variability in the ECG features. Employing the QRS-Polarity algorithm, 34.6% patients had a correct anatomical location, 42.3% had an adjacent location and only 23% an incorrect location. CONCLUSION The QRS-Polarity algorithm has a good global accuracy; its precision is high, especially for left lateral AP. This algorithm is also useful for the parahisian AP.
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Affiliation(s)
- Jorge Gómez-Flores
- Electrophysiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Ángel Cueva-Parra
- Electrophysiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Antonio Gallegos-Cortéz
- Electrophysiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Santiago Nava
- Electrophysiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Manlio F Márquez
- Electrophysiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Pedro Iturralde-Torres
- Electrophysiology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
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29
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El Hamriti M, Braun M, Molatta S, Imnadze G, Khalaph M, Lucas P, Nolting JK, Isgandarova K, Sciacca V, Fink T, Bergau L, Sohns C, Kiuchi K, Nishimori M, Heeger CH, Borlich M, Shin DI, Busch S, Guckel D, Sommer P. EASY-WPW: a novel ECG-algorithm for easy and reliable localization of manifest accessory pathways in children and adults. Europace 2022; 25:600-609. [PMID: 36504238 PMCID: PMC9935024 DOI: 10.1093/europace/euac216] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/23/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS Accessory pathway (AP) ablation is a standard procedure for the treatment of Wolff-Parkinson-White syndrome (WPW). Twelve-lead electrocardiogram (ECG)-based delta wave analysis is essential for predicting ablation sites. Previous algorithms have shown to be complex, time-consuming, and unprecise. We aimed to retrospectively develop and prospectively validate a new, simple ECG-based algorithm considering the patients' heart axis allowing for exact localization of APs in patients undergoing ablation for WPW. METHODS AND RESULTS Our multicentre study included 211 patients undergoing ablation of a single manifest AP due to WPW between 2013 and 2021. The algorithm was developed retrospectively and validated prospectively by comparing its efficacy to two established ones (Pambrun and Arruda). All patients (32 ± 19 years old, 47% female) underwent successful pathway ablation. Prediction of AP-localization was correct in 197 patients (93%) (sensitivity 92%, specificity 99%, PPV 96%, and NPV 99%). Our algorithm was particularly useful in correctly localizing antero-septal/-lateral (sensitivity and specificity 100%) and posteroseptal (sensitivity 98%, specificity 92%) AP in proximity to the tricuspid valve. The accuracy of EASY-WPW was superior compared to the Pambrun (93% vs. 84%, P = 0.003*) and the Arruda algorithm (94% vs. 75%, P < 0.001*). A subgroup analysis of children (n = 58, 12 ± 4 years old, 55% female) revealed superiority to the Arruda algorithm (P < 0.001*). The reproducibility of our algorithm was excellent (ϰ>0.8; P < 0.001*). CONCLUSION The novel EASY-WPW algorithm provides reliable and accurate pre-interventional ablation site determination in WPW patients. Only two steps are necessary to locate left-sided AP, and three steps to determine right-sided AP.
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Affiliation(s)
- Mustapha El Hamriti
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Martin Braun
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Stephan Molatta
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany,Center for Congenital Heart Disease/Pediatric Heart Center, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Guram Imnadze
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Moneeb Khalaph
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Philipp Lucas
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Julia Kathinka Nolting
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Khuraman Isgandarova
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Vanessa Sciacca
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Thomas Fink
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Leonard Bergau
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany,Clinic for Cardiology, University Goettingen, Robert-Koch-Str. 40, 37075 Goettingen, Germany
| | - Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Kunihiko Kiuchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Hospital, 7-5-2 Kusunokicho, Chuo-ku, Kobe City, Japan,Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Hospital, 7-5-2 Kusunokicho, Chuo-ku, Kobe City, Japan
| | - Makoto Nishimori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Hospital, 7-5-2 Kusunokicho, Chuo-ku, Kobe City, Japan
| | - Christian-Hendrik Heeger
- Department of Rhythmology, University Heart Centre Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Martin Borlich
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg), Am Kurpark 1, Bad Segeberg, 23795 Schleswig-Holstein, Germany
| | - Dong-In Shin
- Clinic for Cardiology, Herzzentrum Niederrhein, HELIOS Klinikum Krefeld, Lutherplatz 40, 47805 Krefeld, Germany
| | - Sonia Busch
- Cardiology Department, Klinikum Coburg GmbH, Coburg, Germany
| | | | - Philipp Sommer
- Corresponding author. Tel: +49 5731 97 1327; fax: +49 5731 97 2123. E-mail address:
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Cui C, Li Z, Ju W, Yang G, Gu K, Liu H, Li M, Chen H, Wang J, Chen M. The characteristics of pre-excitation syndrome concomitant with atrial tachyarrhythmia and the effect of radiofrequency ablation. Pacing Clin Electrophysiol 2022; 45:1401-1408. [PMID: 36209460 DOI: 10.1111/pace.14598] [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: 06/21/2022] [Revised: 08/19/2022] [Accepted: 09/02/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Wolff-Parkinson-White (WPW) concomitant with atrial tachyarrhythmia (ATA) has not been systemically characterized. METHODS Detailed electroanatomical mapping of the right atrium (RA) and/or left atrium (LA) was performed using three-dimensional mapping and the accessory pathway (AP) was mapped. RESULTS WPW syndrome with ATA was diagnosed in 11 patients (median age 60 years). The characteristic of unidirectional anterograde conduction over the AP was displayed in nine patients, six of whom were intermittent. Sustained atrial tachycardia, that is, counterclockwise atrial flutter (AFL) with a median tachycardia cycle length (TCL) of 225 (220-275) ms, was mapped in eight patients; furthermore, "figure 8" right atrial reentry was mapped with TCL 250 ms in one patient with a surgical history of ventricular septal defect repair. The remaining two patients underwent mitral annulus-dependent AT after paroxysmal atrial fibrillation (PAF) ablation and LA micro-reentry AT, respectively. In four patients, the location of the APs was left posterior. Left-lateral APs were identified in four patients. The locations of the APs in the remaining three patients were the right posterior and middle septum. All ATAs and APs were successfully ablated. After a median follow-up of 37 (15-72) months, no anterograde conduction over the AP was recorded, new onset of PAF was recorded in three patients, and all of them underwent circumferential pulmonary vein isolation. CONCLUSIONS WPW with concomitant ATA frequently had continuous anterograde conduction over the AP with a rapid ventricular rate. Most WPWs displayed the characteristic of unidirectional anterograde conduction.
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Affiliation(s)
- Chang Cui
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhaomin Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weizhu Ju
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Gang Yang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kai Gu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hailei Liu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mingfang Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hongwu Chen
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Wang
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Minglong Chen
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Dogdus M, Dindas F, Turan OE, Yilancioglu RY, Ozgul U, Inevi UD, Ozcan EE. Evaluation of left atrial and left ventricular functions in patients with Wolff-Parkinson-White syndrome before and after radiofrequency catheter ablation using three-dimensional speckle tracking echocardiography. Echocardiography 2022; 39:1488-1495. [PMID: 36319479 DOI: 10.1111/echo.15473] [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: 06/20/2022] [Revised: 09/19/2022] [Accepted: 10/02/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Wolff-Parkinson-White (WPW) syndrome is one of the most common congenital cardiac abnormalities among ventricular pre-excitation syndromes. Radiofrequency catheter ablation (RFCA) treatment of accessory pathways (APs) in WPW patients is an established curative therapy restoring normal atrioventricular conduction. We have not encountered any studies evaluating both the LA and LV functions of these patients before and after RFCA with three dimensional-speckle tracking echocardiography (3D-speckle tracking echocardiography (STE)). AIM The purpose of the current study was to assess the LA and LV functions in patients with WPW syndrome before and after RFCA using 3D-STE. METHODS A total of 21 patients with WPW syndrome who had been scheduled for RFCA were prospectively recruited for this study. 3D-STE examinations of the patients were performed 12-24 h before ablation and 1 month after ablation. RESULTS The LV-global longitudinal strain (LV-GLS) and LV-global circumferential strain (LV-GCS) were significantly depressed in the pre-RFCA WPW group than in the control group (-14.3 ± 2.1 vs. -21.5 ± 2.2, p < .001; -12.6 ± 1.8 vs. -20.4 ± 1.8, p < .001, respectively). The left atrial strain-reservoir (LAS-r) and LAS-active were significantly decreased in the pre-RFCA WPW group than in the control group (31.9 ± 2.4 vs. 48.8 ± 2.6, p < .001; 11.7 ± 2 vs. 26.5 ± 2.1, p < .001, respectively). The LV-GLS, LV-GCS, LAS-r, and LAS-active values improved after RFCA compared to before. CONCLUSION The results of our study indicated that there are subclinical impairments in LV and LA myocardial dynamics in the apparently healthy WPW patients, and these deteriorations improve after RFCA of AP.
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Affiliation(s)
- Mustafa Dogdus
- Department of Cardiology, Training and Research Hospital, Usak University, Usak, Turkey
| | - Ferhat Dindas
- Department of Cardiology, Training and Research Hospital, Usak University, Usak, Turkey
| | - Oguzhan Ekrem Turan
- Heart Rhythm Management Center, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | | | - Ufuk Ozgul
- Department of Cardiology, Aydin Ataturk State Hospital, Aydin, Turkey
| | | | - Emin Evren Ozcan
- Heart Rhythm Management Center, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Uniat J, Silka MJ. Risk assessment of pre-excitation: Atrial fibrillation versus atrial flutter. HeartRhythm Case Rep 2022; 9:31-33. [PMID: 36685684 PMCID: PMC9845542 DOI: 10.1016/j.hrcr.2022.10.003] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jonathan Uniat
- Address reprint requests and correspondence: Dr Jonathan Uniat, Children’s Hospital Los Angeles, 4650 Sunset Blvd, MS #34, Los Angeles, CA 90027.
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Verbeet T, Nguyen T, Almorad A, Knecht S, Lousberg P, Castro J. Wide irregular QRS tachycardia: is there something hidden? Acta Cardiol 2022; 77:756-757. [PMID: 34353228 DOI: 10.1080/00015385.2021.1949104] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Thierry Verbeet
- University Hospital Brugmann, Free University of Brussels, Brussels, Belgium
| | - Thomas Nguyen
- University Hospital Brugmann, Free University of Brussels, Brussels, Belgium
| | - Alexandre Almorad
- University Hospital Brugmann, Free University of Brussels, Brussels, Belgium
| | | | | | - José Castro
- University Hospital Brugmann, Free University of Brussels, Brussels, Belgium
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Chaloupecký V, Gebauer R, Kovanda J, Koubský K, Sus I, Janoušek J. Electrophysiology and surgery intertwined in complex treatment of Ebstein's anomaly in childhood. HeartRhythm Case Rep 2022; 9:17-22. [PMID: 36685680 PMCID: PMC9845553 DOI: 10.1016/j.hrcr.2022.09.014] [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: 01/25/2023] Open
Affiliation(s)
- Václav Chaloupecký
- Children’s Heart Centre, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic,Address reprint requests and correspondence: Dr Václav Chaloupecký Jr, Children’s Heart Centre, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Hošťálkova 605/58, Prague 169 00, Czech Republic.
| | - Roman Gebauer
- Children’s Heart Centre, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Jan Kovanda
- Children’s Heart Centre, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Karel Koubský
- Children’s Heart Centre, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Ioana Sus
- Emergency Institute for Cardiovascular Disease and Transplantation, Tirgu Mures, Romania
| | - Jan Janoušek
- Children’s Heart Centre, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
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35
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Choi Y, Kim SH, Kim H, Park JW, Ha YW, Hwang Y, Kim JH, Jang SW, Oh YS. The advantage of mini electrode-equipped catheter for the radiofrequency ablation of paroxysmal supraventricular tachycardia. J Cardiovasc Electrophysiol 2022; 33:2164-2171. [PMID: 35924472 DOI: 10.1111/jce.15639] [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: 04/19/2022] [Revised: 05/26/2022] [Accepted: 06/05/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Novel ablation catheters equipped with mini-electrodes (ME) offer high resolution mapping for target tissue. This study aimed to evaluate the mapping performance and efficacy of ME catheters in radiofrequency ablation (RFA) of paroxysmal supraventricular tachycardias (PSVTs). METHODS We prospectively enrolled 136 patients undergoing RFA of PSVT including 76 patients with atrioventricular nodal reentrant tachycardia (AVNRT) and 60 patients with atrioventricular reentrant tachycardia (AVRT) or Wolff-Parkinson-White (WPW) syndrome. Patients were randomized to the ME group (ablation using ME catheters) or the control group (ablation using conventional catheters). The number of ablation attempt and cumulative ablation time to ablation endpoints, which was defined as an emergence of junctional rhythm in AVNRT or accessory pathway (AP) block in AVRT/WPW syndromes were compared. RESULTS During ablation procedures, discrete slow pathway or AP electrograms were found in 27 (39.7%) patients in the ME group and 13 (19.1%) patients in the control group. The primary study outcomes were significantly lower in the ME group (ablation attempt number: 2.0 [1-4] vs. 3.0 [2-7] in the ME and control group, p=0.032; ablation time: 23.5 [5.0-111.5] vs. 64.5 [16.0-185.0] seconds, p=0.013). According to the PSVT diagnosis, ablation time to junctional rhythm was significantly shorter in the ME group in AVNRT. In AVRT/WPW syndrome, both ablation attempt number and ablation time to AP block were non-significantly lower in the ME group. CONCLUSION The novel ME catheter was advantageous for identifying pathway potentials and reducing initial ablation attempt number and ablation time to reach acute ablation endpoint for PSVTs. (ClinicalTrials.gov number, NCT04215640) This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Young Choi
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Hwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hwajung Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong-Wook Park
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Woong Ha
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youmi Hwang
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Ji-Hoon Kim
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Sung-Won Jang
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-Seog Oh
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Iwasawa J, Koruth JS. The Mini Electrode-equipped Catheter: Utility for Paroxysmal Supraventricular Tachycardia Ablation. J Cardiovasc Electrophysiol 2022; 33:2172-2173. [PMID: 35924477 DOI: 10.1111/jce.15640] [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: 07/08/2022] [Revised: 08/01/2022] [Accepted: 08/01/2022] [Indexed: 12/01/2022]
Abstract
The role of catheter ablation for paroxysmal supraventricular arrhythmias (PSVT) is well established given that it is often a simple, safe, and successful procedure. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jin Iwasawa
- Cardiovascular Center, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Jacob S Koruth
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Bera D, Mukherjee SS, Halder A, Ray A. Inferior lead QRS discordance on surface electrocardiogram predicting right anterior accessory pathways: A simplified approach. J Cardiovasc Electrophysiol 2022; 33:1909-1910. [PMID: 35710697 DOI: 10.1111/jce.15603] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Debabrata Bera
- Department of Cardiology, Rabindranath Tagore International Institute of Cardiac Sciences (RTIICS), Kolkata, West Bengal, India
| | - Sanjeev S Mukherjee
- Department of Cardiology, Medica Superspeciality, Kolkata, West Bengal, India
| | - Antareep Halder
- Department of Cardiology, Rabindranath Tagore International Institute of Cardiac Sciences (RTIICS), Kolkata, West Bengal, India
| | - Adrita Ray
- Department of Cardiology, Rabindranath Tagore International Institute of Cardiac Sciences (RTIICS), Kolkata, West Bengal, India
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Chen W, Xiao P, Zhou G, Liu Z, Chen S, Du H, Li D, Zhang C, Xu Y, Su L, Liu S, Ling Z, Yin Y. Emergency catheter ablation: A feasible option for acute treatments of patients with unstable pre-excited atrial fibrillation. Pacing Clin Electrophysiol 2022; 45:975-983. [PMID: 35363390 DOI: 10.1111/pace.14499] [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: 02/01/2022] [Revised: 03/20/2022] [Accepted: 03/25/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pre-excited atrial fibrillation (AF) is associated with increased risk of life-threatening events. However, at times, patients with pre-excited AF still repetitively suffer from hemodynamic disturbance, with resistance to acute treatments of antiarrhythmic therapy and cardioversion. METHODS To evaluate the feasibility in correcting hemodynamic disturbance, patients with pre-excited AF who underwent catheter ablation of accessory pathway as an emergency procedure, were retrospectively collected from two centers of China. The medical records of patients were analyzed and summarized in this case series. RESULTS Five patients with pre-excited AF who received emergency catheter ablation of accessory pathway, were collected from two contributor centers and reported in this case series. All collected patients still repetitively suffered from hemodynamic disturbance induced by rapid anterograde conduction of AF via pathway, even guideline recommended acute interventions of intravenous antiarrhythmic therapy and cardioversion had been performed. Finally, as an emergency procedure, catheter ablation of accessory pathway was performed in collected patients. Correspondingly, the hemodynamic unstable status was greatly relieved. Meanwhile, all collected patients with high risk of pre-excited AF were combined with left-sided accessory pathway, with shortest RR interval of widened pre-excited QRS complex less than 250ms. Thus, combination with left-sided pathway is proposed as an indicator for the increased risk of life-threatening events in patients with high risk of pre-excited AF. CONCLUSIONS Emergency catheter ablation of accessory pathway is an effective option for the acute managements of patients with high risk of pre-excited AF in unstable hemodynamics, which is resistant to antiarrhythmic therapy and cardioversion. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Weijie Chen
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peilin Xiao
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Genqing Zhou
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Zengzhang Liu
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Songwen Chen
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Huaan Du
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dan Li
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Changzhi Zhang
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanping Xu
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Su
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shaowen Liu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Zhiyu Ling
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuehui Yin
- Department of Cardiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Austin KM, Alexander ME, Triedman JK. Pediatric T-wave memory after accessory pathway ablation in Wolff-Parkinson-White syndrome. Heart Rhythm 2022; 19:459-465. [PMID: 34767987 PMCID: PMC9026902 DOI: 10.1016/j.hrthm.2021.11.007] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/20/2021] [Accepted: 11/03/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Altered ventricular depolarization due to manifest accessory pathway conduction (ie, Wolff-Parkinson-White syndrome) leads to repolarization abnormalities that persist after pathway ablation. The term T-wave memory (TWM) has been applied to these changes, as the postablation T-wave vector "remembers" the pre-excited QRS vector. In adults, these abnormalities can be misinterpreted as ischemia leading to unnecessary interventions. To date, no comprehensive studies have evaluated this phenomenon in the pediatric population. OBJECTIVE The purpose of this study was to define TWM in the pediatric population, identify preablation risk factors, and delineate the timeline of recovery. METHODS Pre- and postablation electrocardiograms (ECGs) in patients ≤25 years were analyzed over a 5-year period. Frontal plane QTc interval, T-wave axis, QRST angle, and T-wave inversions were used to identify patients with TWM. Univariate analysis was performed to determine the association of preablation ECG features with the outcome of TWM. RESULTS TWM was present in 42% of pediatric patients, with resolution occurring within 3 months of ablation. Preablation QRS axis <0° was a strong predictor of TWM (odds ratio [OR] 15.2; 95% confidence interval [CI] 5.7-40), followed by posteroseptal pathway location (right posteroseptal-OR 8.9; 95% CI 4.2-18.8; left posteroseptal-OR 6.1; 95% CI 1.7-22.3). The degree of pre-excitation had a modest association with the development of TWM. No adverse events were observed. CONCLUSION TWM is less common in children compared to adults, and normalization occurred within 3 months postablation. The most predictive features for the development of TWM include a leftward pre-excited QRS axis and posteroseptal pathway location.
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Affiliation(s)
- Karyn M Austin
- Arrhythmia Service, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
| | - Mark E Alexander
- Arrhythmia Service, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - John K Triedman
- Arrhythmia Service, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Raber I, Palmeri NO, Tahir UA, Zimetbaum PJ. A Pacemaker Red Herring and a Hypertrophic Cardiomyopathy Copycat. Circulation 2022; 145:622-625. [PMID: 35188796 DOI: 10.1161/circulationaha.121.058658] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Inbar Raber
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Nicholas O Palmeri
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Usman A Tahir
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Peter J Zimetbaum
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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41
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Masukume G, Dixon M. Wolff-Parkinson-White syndrome type B. Pan Afr Med J 2022; 43:177. [PMID: 36879639 PMCID: PMC9984831 DOI: 10.11604/pamj.2022.43.177.32528] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
| | - Mark Dixon
- National University of Science and Technology, Bulawayo, Zimbabwe
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Chen X, Fu L, He J, Bai R, Zeng S, Liao H, Deng H, Xue Y, Wu S, Liu Y. A Frequent Observation of Wolff-Parkinson-White Syndrome and Fasciculoventricular Pathways in Patients With Danon Disease. Circ J 2021; 86:309-318. [PMID: 34937809 DOI: 10.1253/circj.cj-21-0572] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND Danon disease is typically associated with cardiomyopathy and ventricular pre-excitation. The study aimed to characterize the clinical profile of Danon disease, analyze electrocardiographic (ECG) and electrophysiologic features, and investigate their association with Wolff-Parkinson-White (WPW) syndrome and fasciculoventricular pathways (FVPs).Methods and Results:Clinical course, family history, ECG and electrophysiological data were collected from 16 patients with Danon disease. Over 0.4-8 years of follow up, 1 female patient died suddenly, and 5 male patients died of progressive heart failure by age 13-20 years. Family history analysis revealed that 3 mothers experienced hospitalization or death for heart failure at age 28-41 years. There was 100% penetrance for ECG abnormalities in 13 patients with original ECGs. Short PR intervals and delta waves were present in 9 and 8 patients, respectively. There were significant age-associated increases in the QRS complex width (r=0.556, P=0.048) and the number of leads with notched QRS (r=0.575, P=0.04). Four patients who underwent electrophysiological studies all had FVPs, and 2 of them still had left-side atrioventricular pathways. CONCLUSIONS Danon disease causes a malignant clinical course characterized by early death caused by heart failure in both genders and progressive ECG changes as patients age. The pre-excited ECG pattern is related to FVPs and WPW, which is suggestive of extensive cardiac involvement.
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Affiliation(s)
- Xin Chen
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Provincial People's Hospital
| | - Lijun Fu
- Department of Cardiology, Shanghai Children's Medical Center
| | - Jiqiang He
- Department of Cardiology, Beijing Anzhen Hospital
| | - Rong Bai
- Department of Cardiology, Beijing Anzhen Hospital
| | - Shaoying Zeng
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Provincial People's Hospital
| | - Hongtao Liao
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Provincial People's Hospital
| | - Hai Deng
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Provincial People's Hospital
| | - Yumei Xue
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Provincial People's Hospital
| | - Shulin Wu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Provincial People's Hospital
| | - Yang Liu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Provincial People's Hospital
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43
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Shimura M, Onuki T, Sugiyama Y, Matsuhashi T, Ebihara T, Fushimi T, Tajika M, Ichimoto K, Matsunaga A, Tsuruoka T, Nitta KR, Imai-Okazaki A, Yatsuka Y, Kishita Y, Ohtake A, Okazaki Y, Murayama K. Development of Leigh syndrome with a high probability of cardiac manifestations in infantile-onset patients with m.14453G > A. Mitochondrion 2021; 63:1-8. [PMID: 34933128 DOI: 10.1016/j.mito.2021.12.005] [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: 08/17/2021] [Revised: 11/24/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
The m.14453G > A mutation in MT-ND6 has been described in a few patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes or Leigh syndrome.However, the clinical spectrum and molecular characteristics are unclear.Here, we present four infantile-onset patients with m.14453G > A-associated Leigh syndrome. All four patients had brainstem lesions with basal ganglia lesions, and two patients had cardiac manifestations. Decreased ND6 protein expression and immunoreactivity were observed in patient-derived samples. There was no clear correlation between heteroplasmy levels and onset age or between heteroplasmy levels and phenotype; however, infantile onset was associated with Leigh syndrome.
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Affiliation(s)
- Masaru Shimura
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Takanori Onuki
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Yohei Sugiyama
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Tetsuro Matsuhashi
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Tomohiro Ebihara
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Takuya Fushimi
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Makiko Tajika
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Keiko Ichimoto
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Ayako Matsunaga
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Tomoko Tsuruoka
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Kazuhiro R Nitta
- Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Hongo 2-1-1 Bunkyo-ku, Tokyo 113-8421, Japan
| | - Atsuko Imai-Okazaki
- Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Hongo 2-1-1 Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yukiko Yatsuka
- Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Hongo 2-1-1 Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yoshihito Kishita
- Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Hongo 2-1-1 Bunkyo-ku, Tokyo 113-8421, Japan; Department of Life Science, Faculty of Science and Engineering, Kindai University, 3-4-1 Kowakae, Higashiosaka, Osaka 577-8502, Japan
| | - Akira Ohtake
- Department of Pediatrics & Clinical Genomics, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
| | - Yasushi Okazaki
- Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Hongo 2-1-1 Bunkyo-ku, Tokyo 113-8421, Japan
| | - Kei Murayama
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan; Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Hongo 2-1-1 Bunkyo-ku, Tokyo 113-8421, Japan.
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Janson CM, Millenson ME, Okunowo O, Dai D, Christmyer Z, Tan RB, Ramesh Iyer V, Shah MJ, O'Byrne ML. Incidence of life-threatening events in children with Wolff-Parkinson-White syndrome: Analysis of a large claims database. Heart Rhythm 2021; 19:642-647. [PMID: 34902591 DOI: 10.1016/j.hrthm.2021.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/07/2021] [Revised: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Previous estimates of life-threatening event (LTE) risk in Wolff-Parkinson-White (WPW) syndrome are limited by selection bias inherent to tertiary referral-based cohorts. OBJECTIVE This analysis sought to measure LTE incidence in children with WPW syndrome in a large contemporary representative population. METHODS A retrospective cohort study was conducted using claims data from the IBM MarketScan Research Databases, evaluating patients with WPW syndrome (age 1-18 years) from any encounter between January 1, 2013, and December 31, 2018. Subjects with congenital heart disease and cardiomyopathy were excluded. The primary outcome was diagnosis of ventricular fibrillation (VF); a composite outcome, LTE, was defined as occurrence of VF and/or cardiac arrest. VF and LTE rates were compared to matched representative controls without WPW syndrome (3:1 ratio). RESULTS The prevalence of WPW syndrome was 0.03% (8733/26,684,581) over a median follow-up of 1.6 years (interquartile range 0.7-2.9 years). Excluding congenital heart disease/cardiomyopathy, 6946 subjects were analyzed. LTE occurred in 49 subjects, including VF in 20. The incidence of VF was 0.8 events per 1000 person-years, and the incidence of LTE was 1.9 events per 1000 person-years. There were no occurrences of VF in controls; the rate of LTE was 70 times higher in patients with WPW syndrome (0.7%; 95% confidence interval 0.5%-0.9%) than in controls (0.01%; 95% confidence interval 0%-0.02%). CONCLUSION The use of a large claims data set allowed for an evaluation of VF and LTE risk in an unselected pediatric population with WPW syndrome. The observed range of 0.8-1.9 events per 1000 person-years is consistent with prior reports from selected populations. A comparison of event rates to matched controls confirms and quantifies the significant elevation in VF and LTE risk in pediatric WPW syndrome.
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Affiliation(s)
- Christopher M Janson
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Marisa E Millenson
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania
| | - Oluwatimilehin Okunowo
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Dingwei Dai
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania
| | - Zane Christmyer
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Reina Bianca Tan
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - V Ramesh Iyer
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maully J Shah
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael L O'Byrne
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania; Leonard Davis Institute and Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia, Pennsylvania
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45
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Mun E, Hong J, Kwon S, Lee SH, Kim W, Lee C. Digital health care and arrhythmia: a case of WPW syndrome in South Korea, 2020. Ann Occup Environ Med 2021; 33:e8. [PMID: 34754469 DOI: 10.35371/aoem.2021.33.e8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 03/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background The digital health care field is expanding from the daily monitoring of chronic diseases to the detection of acute diseases, such as arrhythmia. Wolff-Parkinson-White (WPW) syndrome, a congenital cardiac disorder due to accessory pathways, causes tachycardia, syncope, and even sudden death. Case presentation We presented a 26-year-old female office worker with WPW syndrome managing the disease with a wearable device and discussed its significance in occupational medicine. After reviewing the worker's electrocardiogram results, symptoms, and pulse rate records extracted from the wearable device, we referred the worker to a cardiologist for further evaluations such as electrophysiology study. The worker monitors her symptom recurrence with the wearable device following successful radiofrequency catheter ablation of the bypass tract. Conclusions A case of an office worker with WPW syndrome managing the disease using a smart watch is presented. Further research is required to ensure its scientific validity, and we suggest policymakers promptly introduce digital health care to occupational environments.
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Miyamoto T, Oginosawa Y, Yagyu K, Yamagishi Y, Tsukahara K, Ohe H, Kohno R, Abe H, Kataoka M. Accessory pathway ablation during atrial fibrillation in Ebstein anomaly. Pacing Clin Electrophysiol 2021; 45:431-434. [PMID: 34752651 DOI: 10.1111/pace.14404] [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] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/27/2021] [Accepted: 11/05/2021] [Indexed: 12/01/2022]
Abstract
An 84-year-old woman with type B Wolff-Parkinson-White (WPW) with Ebstein anomaly was admitted with heart failure. She had rapid wide QRS tachycardia due to accessory pathway (AP) conduction associated with atrial fibrillation (AF). Since transesophageal echocardiography before catheter ablation showed a left atrial thrombus, ablation was performed using a 3D mapping system under AF. After marking the functional tricuspid anulus with intra-cardiac echocardiography, 3D intra-cardiac electrogram visualization (ripple map) during AF enabled clear identification of location of the AP. After ablation, there was no complication of cerebral infarction, and the heart failure improved.
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Affiliation(s)
- Taro Miyamoto
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yasushi Oginosawa
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Keishiro Yagyu
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yasunobu Yamagishi
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Keita Tsukahara
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hisaharu Ohe
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Ritsuko Kohno
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Masaharu Kataoka
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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47
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Wang L, Zhao Y, Ma L. Case Report: Coexistent Wolff-Parkinson-White Syndrome and Brugada Phenocopy in a Patient With Pneumonia and Myocarditis. Front Cardiovasc Med 2021; 8:711364. [PMID: 34746247 PMCID: PMC8566699 DOI: 10.3389/fcvm.2021.711364] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/24/2021] [Indexed: 12/01/2022] Open
Abstract
Background: In recent years, Wolff-Parkinson-White (WPW) syndrome and Brugada electrocardiogram (ECG) patterns have been reported as coexistent in the same patient. In most cases, the two waveforms appeared separately. Here, we described combinations of different waveforms on one ECG, such as the Brugada pattern with delta waves and the Brugada pattern with paroxysmal supraventricular tachycardia (PSVT). Importantly, we recorded an alternate conversion of these combined ECG waveforms, which has not previously been reported in the literature. At the same time, we confirmed that the change in the waveform was related to fever by analyzing Holter data. Case: A 48-year-old male was admitted to our hospital due to palpitations and fever. The patient had a history of a cold 3 days ago. Laboratory examinations showed an elevated neutrophil percentage (85%) and troponin I level (0.86 ng/ml). A chest computed tomography (CT) scan showed inflammation in the right lung. The diagnosis of pneumonia and myocarditis was made. ECG indicated WPW syndrome and the Brugada pattern. We recorded the dynamic changes in this combination of delta waves and Brugada waves with a Holter monitor, and we found the changes would happen when the patient's body temperature rose. The doctors thought that the patient's pulmonary infection led to fever, which caused the changes in waveform. After treatment with antibacterial therapy and supportive care, his body temperature returned to normal. The various laboratory indicators also gradually returned to normal. The doctor recommended that the patient undergo further pre-excitation bypass radiofrequency ablation treatment, but the patient refused and was discharged. Conclusion: Delta waves and Brugada ECG patterns could appear on one ECG at the same time. There were dynamic changes of QRS complex, relating to fever.
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Affiliation(s)
- Li Wang
- Department of Electrocardiogram Diagnosis, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yana Zhao
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lan Ma
- Department of Electrocardiogram Diagnosis, Second Affiliated Hospital of Anhui Medical University, Hefei, China
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Selcuk SN, Ertugrul İ, Karagoz T. Giant diverticulum of coronary sinus with multiple accessory pathways treated with catheter ablation. Cardiol Young 2021; 32:1-4. [PMID: 34551842 DOI: 10.1017/s1047951121003371] [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] [Indexed: 11/07/2022]
Abstract
Coronary sinus abnormalities are usually associated with arrhythmia disorders when symptomatic. We report a 5-year-old 14 kg patient with a giant diverticulum of coronary sinus and Wolff-Parkinson-White syndrome. Catheter ablation therapy was decided during follow-up due to inadequate response to multidrug therapy. Posteroseptal and left posterolateral accessory pathways were established and radiofrequency ablation was performed successfully through coronary sinus.
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Affiliation(s)
- Sinem N Selcuk
- Division of Pediatric Cardiology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İlker Ertugrul
- Division of Pediatric Cardiology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tevfik Karagoz
- Division of Pediatric Cardiology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Miyazaki A, Uemura H. Perspective of preexcitation induced cardiomyopathy; early septal contraction, and subsequent rebound stretch. J Cardiol 2021; 79:30-35. [PMID: 34497028 DOI: 10.1016/j.jjcc.2021.08.017] [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: 06/15/2021] [Revised: 07/08/2021] [Accepted: 08/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Preexcitation-induced cardiomyopathy (PIC) is defined as a disease presenting ventricular dyssynchrony because of preexcitation through an accessory pathway (AP), being a cousin of pacing-induced cardiomyopathy. The present review aims at providing perspective of this uncharted subgroup. METHODS In order to determine mechanisms and clinical characteristics of PIC, 63 patients in 29 literature reports were reviewed. RESULTS A median age at onset was 4 (0.1-59) years; 55 patients (87%) under 18 years old including 16 infants. Twenty patients (32%) experienced supraventricular tachycardia prior and subsequent to the PIC onset. Heart failure and left ventricular (LV) dysfunction did not correlate with other clinical features. All the 65 APs identified (duplicated in 2 patients) were located on the right side of the atrioventricular junction; at the septal area (in 55%) or the anterolateral aspect (in 22%). AP conduction was successfully eliminated by medical or interventional treatments where attempted. LV function returned to normal within 6 months in 67% of patients, while recovery took longer than 3 years in 8%. Frequently seen at the basal segments of the interventricular septum were early contraction within the QRS complex, dyskinesis at mid-systole, and aneurysm/bulging or local thinning. CONCLUSIONS Several characteristic factors became clear as described above. Rebound stretch following early shortening of the interventricular septum is seemingly the major mechanism of PIC, and thus a right septal or right anterior/anterolateral AP needs attention as a higher risk for PIC.
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Affiliation(s)
- Aya Miyazaki
- Congenital Heart Disease Center, Nara Medical University, Nara, Japan; Department of Transitional Medicine, Division of Congenital Heart Disease, Shizuoka General Hospital, Shizuoka, Japan; Department of Cardiology, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan.
| | - Hideki Uemura
- Congenital Heart Disease Center, Nara Medical University, Nara, Japan
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50
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Morady F. Diagnosis and cure of supraventricular tachycardia. Heart Rhythm 2021; 18:651-652. [PMID: 33795072 DOI: 10.1016/j.hrthm.2020.11.010] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 10/21/2022]
Affiliation(s)
- Fred Morady
- Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
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