Search

Fetal autoimmune atrioventricular block (AVB) is a rare but potentially lifethreatening condition. It results from the passage of maternal anti-SSA/Ro or Anti SSB/La auto-antibodies into the fetal circulation, leading to inflammation and fibrosis of the AV node and often to irreversible damage. Besides AVB, these antibodies can also cause cardiomyopathies, but there is no evidence linking them to tachyarrhythmias. We present the case of a patient with significant risk factors for fetal AVB: a prior history of hydrops fetalis, high anti-SSA/Ro antibody levels and hypothyroidism. In this case, the use of dexamethasone and intravenous immunoglobulin may have contributed to reversing the first degree atrioventricular block detected at 19 weeks of gestation. Additionally, at 21 weeks, the fetus developed a tachyarrhythmia that needed treatment with flecainide. Soon after the birth, the newborn underwent ECG Holter and Wolff-Parkinson-White Syndrome (WPWS) was diagnosed. To our knowledge, the coexistence of fetal AVB and WPWS has never been described. [ABSTRACT FROM AUTHOR]

A 72-year-old Brazilian woman presented with a 4-year history of rest tremors of the hands, followed by slowness of movement, and a diagnosis of idiopathic Parkinson’s disease. She was started on dopamine agonists with significant improvement. After three years, she complained about slowly progressive dysphagia, dysphonia, quadriparesis, and cramps and fasciculations. A neurological examination disclosed distal-dominant quadriparesis, dysarthria, atrophy and fasciculation of the tongue, global brisk tendon reflexes, fasciculations, bilateral ankle clonus, and moderate spasticity of the lower limbs. She had also palpitations, dyspnea, and one episode of paroxysmal atrial fibrillation. Electrocardiography revealed a short PR interval, a widened QRS complex, and the delta wave, suggestive of Wolff–Parkinson–White syndrome. Brain and spine MR imaging, a cerebrospinal fluid analysis, and general serum lab exams were unremarkable. Needle electromyography disclosed chronic denervation involving cervical, thoracic, lumbosacral, and bulbar levels associated with acute denervation, including positive sharp waves, fasciculations, and fibrillation potentials. This patient fulfilled the diagnostic criteria for amyotrophic lateral sclerosis associated with parkinsonism. A broad next-generation sequencing-based panel disclosed the presence of the novel heterozygous variant c.1247C > T (p.Pro416Leu) in the PRKAG2 gene (NM_016203.4). Clinicians must be aware of the possibility of PRKAG2 variants in complex clinical scenarios associating cardiac arrhythmia, preexcitation syndromes, hypertrophic cardiomyopathy, motor neuron disease, and parkinsonism.

The non-invasive localization of accessory pathway (AP) in patients with Wolff-Parkinson-White (WPW) syndrome is typically performed upon physicians’ diagnoses based on observing their electrocardiogram (ECG) signals, which are not always the same. Therefore, a high-accuracy automatic method can help minimize this gap regarding AP localization. This study was to develop a novel semi-automatic localization of AP in patients with WPW syndrome, using features selected from the cross-recurrence plot (CRP) of consecutive precordial leads on ECG. The study participants comprised of 31 patients with WPW syndrome (aged 8-69, with the mean age of 31.19±14.69, 32.3% female), receiving successful ablation therapy during the first session. The features extracted from the CRP, including laminarity (LAM), trapping time (TT), determinism (DET), and mean length of diagonal line (L) were then analyzed. The feature reduction, The classification and the cross-validation (CV) methods were sequential forward selection (SFS), the k-nearest neighbors (KNN) and the leave-one-out (LOO) respectively. The proposed method could differentiate the right and left APs in the patients with WPW syndrome with the accuracy value of 87% (sensitivity: 93.33%, specificity: 81.25%). These results were achieved by the LAM and L features from the CRP of (V1, V2) and (V3, V4), respectively.

A 12-lead electrocardiogram of a pediatric patient with Wolff–Parkinson–White syndrome was consistent with the anteroseptal accessory pathway. The patient had three ablation procedures because of the recurrences of the arrhythmia. In our case, successful cryoablation was performed in the non-coronary cusp of the aortic root.

This article is an editorial that discusses the use of pharmacological therapy in patients with arrhythmias. It provides information on the prevalence and incidence of different types of arrhythmias, such as supraventricular tachycardia and atrial fibrillation, and their associated risk factors. The article emphasizes the importance of early detection and maintenance of sinus rhythm in patients with atrial fibrillation. It also discusses the use of catheter ablation and additional pharmacological therapy in managing arrhythmias. The article concludes by mentioning the importance of anticoagulation therapy and the potential benefits of direct-acting oral anticoagulants in certain patient populations. The given document is a list of references for various research articles related to heart disease, stroke, and atrial fibrillation. These articles cover topics such as the epidemiology of atrial fibrillation, predictors of specific types of atrial fibrillation, the impact of ablation on mortality, remote monitoring systems for implantable cardiac defibrillators, and the use of artificial intelligence in the treatment of atrial fibrillation. These articles provide valuable information for library patrons conducting research on these specific topics. [Extracted from the article]

Wolff-Parkinson-White (WPW) syndrome is defined by specific electrocardiogram (ECG) changes resulting in ventricular pre-excitation (the so-called WPW pattern), related to the presence of an accessory pathway (AP), combined with recurrent tachyarrhythmias. WPW syndrome is characterized by different supraventricular tachyarrhythmias (SVT), including atrioventricular re-entry tachycardia (AVRT) and atrial fibrillation (AF) with rapid ventricular response, with AVRT being the most common arrhythmia associated with WPW, and AF occurring in up to 50% of patients with WPW. Several mechanisms might be responsible for AF development in the WPW syndrome, and a proper electrocardiographic interpretation is of pivotal importance since misdiagnosing pre-excited AF could lead to the administration of incorrect treatment, potentially inducing ventricular fibrillation (VF). Great awareness of pre-excited AF’s common ECG characteristics as well as associated causes and its treatment is needed to increase diagnostic performance and improve patients’ outcomes. In the present review, starting from a paradigmatic case, we discuss the characteristics of pre-excited AF in the emergency department and its management, focusing on the most common ECG abnormalities, pharmacological and invasive treatment of this rhythm disorder. [ABSTRACT FROM AUTHOR]

Copyright of Revista Argentina de Terapia Intensiva is the property of Sociedad Argentina de Terapia Intensiva (SATI) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Long QT syndrome (LQT) and WPW syndrome are causes of sudden cardiac death (SCD) in the young, and their association has been rarely reported. A 26-year-old woman presented with recurrent syncope. Her ECG showed a short PR interval, wide QRS (150 ms) due to a delta wave, and QT prolongation (QT 580 ms, QTc 648 ms). ECG monitoring documented recurrent salvos of a self-terminating wide QRS tachycardia, generally slightly polymorphic, sometimes with "torsade des pointes" (TdP) appearance, which were linked to the syncopal/presyncope episodes. Electrophysiologic monitoring diagnosed a right para-hisian accessory pathway with a very short ERP (240 ms baseline, <200 ms after isoproterenol). The pathway was ablated successfully. Despite QRS narrowing (80 ms), QT prolongation persisted after ablation (QT 620 ms, QTc 654 ms), with short runs of TdP, despite beta-blocker treatment, which was increased to the maximal dosage. A dual-chamber implantable cardioverter defibrillator (ICD) was implanted. To our knowledge, this is the first case report of an association between LQT and WPW syndrome in which both conditions are associated with an increased risk of SCD. [ABSTRACT FROM AUTHOR]

Wolf–Parkinson–White (WPW) syndrome is a disorder characterized by the presence of at least one accessory pathway (AP) that can predispose people to atrial/ventricular tachyarrhythmias and even sudden cardiac death. It is the second most common cause of paroxysmal supraventricular tachycardia in most parts of the world, affecting about 0.1–0.3% of the general population. Most patients with WPW syndrome have normal anatomy, but it may be associated with concomitant congenital heart disease or systemic diseases. Although many individuals are asymptomatic, during supraventricular arrhythmia episodes, they may experience severe symptoms, including syncope or even sudden cardiac death (mainly due to pre-excited atrial fibrillation over rapidly conducting AP). In addition to arrhythmia-related symptoms, for some specific locations of the APs with overt anterograde conduction, there might be a reduction in exercise capacity mediated by a reduction in LV systolic performance due to anomalous LV depolarization. Although it is typically diagnosed through electrocardiography (ECG), additional tests are necessary for risk assessment. Management of WPW syndrome may be quite challenging and can vary from only acknowledging the presence of the accessory pathway to pharmacological treatment or radiofrequency ablation. Early diagnosis, risk assessment, and appropriate treatment are critical steps in the management of WPW syndrome, aiming to improve the quality of life and reduce the risk of life-threatening arrhythmias. [ABSTRACT FROM AUTHOR]

Aims Controversy remains as to whether the exercise stress test (EST) is sufficient for risk evaluation in patients with pre-excitation. This study aims to clarify the usefulness of EST in risk stratification in both asymptomatic and symptomatic patients presenting with pre-excitation. Methods and results This prospective study includes consecutive asymptomatic and symptomatic patients with pre-excitation referred for risk assessment. All participants performed an incremental EST (bicycle) prior to an electrophysiology study (EPS). Primary data from the EST included loss of pre-excitation during exercise, and primary data from the EPS included the measurement of accessory pathway effective refractory period (APERP), shortest pre-excited RR interval (SPERRI), and inducible arrhythmia with the use of a beta-adrenergic receptor agonist if deemed necessary. One hundred and sixty-four patients (59 asymptomatic, 105 symptomatic) completed an EST and EPS. Forty-five patients (27%) demonstrated low-risk findings on EST, of which 19 were asymptomatic and 26 were symptomatic. Six patients with low-risk EST findings had SPERRI/APERP ≤ 250 ms at EPS, and two of them were asymptomatic. The sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of low-risk EST for excluding patients with SPERRI/APERP ≤ 250 ms were 40, 91, 87, 51, and 60%, respectively. The number of patients with inducible arrhythmia at EPS was similar in the asymptomatic (36, 69%) and symptomatic (73, 61%) groups. Conclusion Sudden loss of pre-excitation during EST has a low NPV in excluding high-risk APs. The EPS with the use of isoproterenol should be considered to accurately assess the risk of patients with pre-excitation regardless of symptoms (ClinicalTrials.gov Identifier: NCT03301935). [ABSTRACT FROM AUTHOR]

ABSTRACT Objective This study aimed to provide a long-term follow-up of PRKAG2 syndrome and describe the new phenotypic aspects of the condition. PRKAG2 syndrome is a rare autosomal-dominant glycogen storage disease characterized by cardiac hypertrophy, ventricular pre-excitation, and conduction system disease. Fatal arrhythmias occur frequently. Methods A family cohort of 66 participants was recruited. Clinical and genetic analyses were performed. Results Median age of 36.97±17.28 years, with 69.9% being men. Nineteen subjects carried the deleterious variant p.K290I of the PRKAG2 gene. This group experienced many malignant events, including eight pacemaker implants, three sudden cardiac deaths, five aborted cardiac arrests, four strokes, four premature neonatal deaths, two spontaneous abortions, five forceps deliveries, and 12 cesarean procedures. Extracardiac involvement, such as in neurocognitive and psychiatric disorders, has been observed only in carriers of mutations. Palpitations, Syncope, atrial fibrillation, atrial flutter, sinus pauses, and bradycardia were strongly and significantly associated with major or severe adverse events (sudden cardiac death, aborted cardiac arrest, pacemaker use, stroke, and congestive heart failure). Early diagnosis and intervention through antiarrhythmic drugs, anticoagulation, pacemaker implantation, radiofrequency catheter ablation, and cesarean section surgery improved the symptoms and survival rates. Mutations carriers were advised to avoid pregnancy. Conclusion This study identified that the p.K291I_PRKAG2 mutation is associated with poor prognosis, highlighting the need for early intervention. Further research may uncover the potential connections between intellectual disability, miscarriage, and neonatal death in individuals with this syndrome.

Fetal autoimmune atrioventricular block (AVB) is a rare but potentially life-threatening condition. It results from the passage of maternal anti-SSA/Ro or Anti SSB/La auto-antibodies into the fetal circulation, leading to inflammation and fibrosis of the AV node and often to irreversible damage. Besides AVB, these antibodies can also cause cardiomyopathies, but there is no evidence linking them to tachyarrhythmias. We present the case of a patient with significant risk factors for fetal AVB: a prior history of hydrops fetalis, high anti-SSA/Ro antibody levels and hypothyroidism. In this case, the use of dexamethasone and intravenous immunoglobulin may have contributed to reversing the first-degree atrioventricular block detected at 19 weeks of gestation. Additionally, at 21 weeks, the fetus developed a tachyarrhythmia that needed treatment with flecainide. Soon after the birth, the newborn underwent ECG Holter and Wolff-Parkinson-White Syndrome (WPWS) was diagnosed. To our knowledge, the coexistence of fetal AVB and WPWS has never been described.

Background: Wolff-Parkinson-White syndrome is a rare but well-known disease that predisposes a person to cardiac arrhythmias. But sometimes this syndrome is accompanied by heart failure in the affected person. Several causes have been proposed for this complication including recurrent or incessant tachyarrhythmias that are frequently found in symptomatic (especially children) Wolf-Parkinson-White syndrome patients causing heart dysfunction and dilation and dilated cardiomyopathy, and also pre-excitation-related dyssynchrony leading to progressive ventricular remodeling and dilation. In this report, a patient is introduced who has improved his heart failure by radio-frequency ablation of free wall type of this syndrome. Case Presentation: A 35-year-old man who had a history of Wolff-Parkinson-White syndrome from 8 years ago and suffered from dilatation and reduced left ventricular ejection fraction in recent years was presented with a pre-excited atrial fibrillation attack at the emergency department. The initial surface ECG showed positive delta wave in all precordial leads and negative QRS complexes in interior leads with QRS duration of about 200 ms. He had undergone electrophysiology study and ablation at the left postero-lateral accessory pathway. After ablation of accessory pathway within the months (from November 2022 until June 2023), left ventricular function was gradually improved and the symptoms of the patient's shortness of breath were also decreased. Conclusion: The existence of heart failure in patients with Wolff-Parkinson-White syndrome can be due to various reasons including the presence of an accessory pathway and the dyssynchrony of intraventricular contraction which is caused by premature excitation of the connected part of the left ventricle by accessory atrioventricular pathway. Although in order to rule out the possibility of the incidental association of the accessory pathway with primary dilated cardiomyopathy and to investigate the segmental dyskinesia, it is necessary to perform diagnostic measures such as echocardiography and cardiac computerized tomography and magnetic resonance imaging, ablation of such accessory pathway not only controls arrhythmic attacks but also leads to the improvement of the left ventricular systolic function even in a middle age patient. [ABSTRACT FROM AUTHOR]

There is a rich history of surgery for cardiac arrhythmias, spanning from atrial fibrillation and Wolff–Parkinson–White syndrome to inappropriate sinus tachycardia and ventricular tachycardia. This review describes the history of these operations, their evolution over time, and the current state of practice. We devote considerable time to the discussion of atrial fibrillation, the most common cardiac arrhythmia addressed by surgeons. We discuss ablation of atrial fibrillation as a stand-alone operation and as a concomitant operation performed at the time of cardiac surgery. We also discuss the emergence of newer procedures to address atrial fibrillation in the past decade, such as the convergent procedure and totally thoracoscopic ablation, and their outcomes relative to historic approaches such as the Cox maze procedure. [ABSTRACT FROM AUTHOR]

Delta wave morphology during sinus rhythm on 12 lead ECG usually allows for a relatively precise prediction of the anatomic location of an accessory pathway (AP) provided that the rhythm is fully pre-excited. However, the pre-excitation pattern during sinus rhythm usually offers little information about sudden cardiac death (SCD) risk in adult patients with asymptomatic Wolf-Parkinson-White (WPW). A 42-year-old policeman was referred for an asymptomatic WPW pattern with an unusual delta wave. Initial mapping showed that atrio-ventricular (A-V) fusion on the lateral mitral annulus and radiofrequency (RF) ablation induced a shift in the pre-excitation pattern. Re-mapping identified A-V fusion on the left postero-septal area. Another RF application eliminated pre-excitation. Re-mapping identified A-V fusion on the postero-septal aspect of the mitral annulus and another RF application almost instantaneously induced an A-V split and loss of pre-excitation. Post-ablation testing proved normal anterograde A-V conduction without pre-excitation and no ventriculo-atrial conduction. Serial ECGs proved the persistent loss of pre-excitation at one-month of follow-up. This case highlights the diagnostic challenges associated with atypical pre-excitation patterns and the importance of a thorough evaluation in asymptomatic individuals. Patients with atypical pre-excitation may harbor multiple accessory pathways (MAPs) and should be carefully assessed to mitigate the risk of SCD. [ABSTRACT FROM AUTHOR]

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.

Abstract Background The atrioventricular reentrant tachycardia (AVRT) is the most common tachycardia associated with accessory pathways (APs). Although sporadic Wolff-Parkinson-White (WPW) syndrome has been well-described, AP occurrence in identical twins with WPW syndrome remains rarely reported. Case presentation We report a case of 14-year-old monozygotic twin brothers referred for an electrophysiology (EP) study. Twin A presented with recurrent symptomatic narrow complex tachycardia after exercise, noted for 3 years. His 12-lead surface electrocardiogram (ECG) did not show ventricular pre-excitation. However, an orthodromic AVRT utilizing a concealed right posteroseptal AP was found and successfully ablated. AVRT did not recur 12 months after the procedure. Twin B was asymptomatic. During his medical examination for firefighter volunteerism, his 12-lead ECG showed a spontaneous ventricular pre-excitation. EP study revealed a short anterograde right midseptal AP, which was then successfully eliminated by catheter ablation. His 12-lead ECG showed no ventricular pre-excitation recurrence 12 months after the procedure. Conclusions These identical twin brothers had a right-side AP in almost the same place but showed completely different phenotypes. This case clearly illustrates the difficulty in understanding genetic contribution in the origin of atrioventricular APs. Environmental exposure could play a role in their clinical presentations and AP electrophysiological properties.

Background. Neonatal thromboses, both venous and arterial, are a rare pathology, and experience in systemic thrombolysis is very low. Thus, the methods of adult management are currently being adapted to pediatric practice.Clinical case description. This report describes clinical case of abdominal aortic thrombosis in a premature infant with later diagnosed Wolff-ParkinsonWhite syndrome and acquired hypothyroidism developed due to antiarrhythmic therapy.Conclusion. The premature boy had high comorbidity that required many specialists’ involvement. Timely systemic thrombolytic therapy and antiarrhythmic drugs selection made it possible to save the child's life and most likely to avoid disability in the future.

Abstract Background Wolff–Parkinson–White syndrome is characterized by a short PR interval (delta-wave), long QRS complex, and the appearance of paroxysmal supraventricular tachycardia. Patients with Wolff–Parkinson–White syndrome usually have one accessory pathway, whereas cases with multiple accessory pathways are rare. Persistent left superior vena cava is a vascular anomaly in which the vein drains into the right atrium through the coronary sinus at the junction of the left internal jugular and subclavian veins due to abnormal development of the left cardinal vein. The simultaneous presence of multiple accessory pathways and persistent left superior vena cava has not been reported before. Case presentation A 56-year-old Japanese man with a 5-year history of palpitations was referred for radiofrequency catheter ablation due to increased frequency of tachycardia episodes in the previous 2 months. Persistent left superior vena cava was confirmed by transthoracic echocardiography and computed tomography. An electrophysiological study revealed that the accessory pathways were located in the left lateral wall, anterolateral wall, and posteroseptal region. They were completely ablated with radiofrequency energy application. Conclusions We reported an extremely rare case of a patient with multiple accessory pathways and persistent left superior vena cava. Our case may suggest a potential embryological relationship between the multiple accessory pathways and persistent left superior vena cava.

Wolff-Parkinson-White (WPW) syndrome is defined by specific electrocardiogram (ECG) changes resulting in ventricular pre-excitation (the so-called WPW pattern), related to the presence of an accessory pathway (AP), combined with recurrent tachyarrhythmias. WPW syndrome is characterized by different supraventricular tachyarrhythmias (SVT), including atrioventricular re-entry tachycardia (AVRT) and atrial fibrillation (AF) with rapid ventricular response, with AVRT being the most common arrhythmia associated with WPW, and AF occurring in up to 50% of patients with WPW. Several mechanisms might be responsible for AF development in the WPW syndrome, and a proper electrocardiographic interpretation is of pivotal importance since misdiagnosing pre-excited AF could lead to the administration of incorrect treatment, potentially inducing ventricular fibrillation (VF). Great awareness of pre-excited AF’s common ECG characteristics as well as associated causes and its treatment is needed to increase diagnostic performance and improve patients’ outcomes. In the present review, starting from a paradigmatic case, we discuss the characteristics of pre-excited AF in the emergency department and its management, focusing on the most common ECG abnormalities, pharmacological and invasive treatment of this rhythm disorder.

Wolff-Parkinson-White (WPW) syndrome is a congenital cardiac preexcitation syndrome that presents with an uninhibited electrical conduction between the atria and ventricles via an accessory pathway that has the potential for life-threatening arrhythmias. This is a case report of an asymptomatic/undiagnosed 43-year-old female with an incidental finding of WPW pattern during hardware removal surgery of the right hip while under general anesthesia. The identification of asymptomatic patients can be difficult because there may be only subtle changes on the electrocardiogram but could still pose as life-threatening in the presence of supraventricular tachycardia. Because of the potential risks, recommendations were given to follow up with the cardiology department to establish an accurate diagnosis. After recognition, the perioperative anesthetic goal was to prepare for any potential arrhythmia, minimize triggers, and provide proper follow-up so that appropriate testing could be conducted to properly diagnose and manage WPW. [ABSTRACT FROM AUTHOR]

Objective. We studied the prevalence and major predisposing factors of permanent atrial fibrillation (PAF) in a population of hypertensive post-menopausal (HPMW) women. Materials and Methods. We enrolled 125 consecutive HPMW with PAF, 125 HPMW in sinus rhythm were the control group (CG). Women with valvular heart disease, coronary artery disease, WPW syndrome, left ventricular (LV) ejection fraction <45% and thyroid disorders were excluded. The mean age was similar: 53±3 years for women on PAF and 51±6 for women with sinus rhythm (P<0.45). All women who underwent M-B mode echocardiography, LV mass, function, and left atrial (LA) volume were assessed according to American Society of Echocardiography guidelines. Diabetes was assessed according to American Diabetes Association guidelines. Results. In a population of 8945 consecutive women, 4497 were hypertensive (50.2%) and 125 were on PAF (0.3%). We observed a highly significant difference between the two groups in relation to obesity: 31 (24.8%) in the AF-group and 15 (12%) in CG, Chi-squared 10, P<0.0016, OR 2.8, 95%; to increased LA volume: 37 (29.6%) in AF-group and 13 (10.4%) in CG, Chi-squared 14.4, P<0.0001, OR 3.62, 95%. No difference in diabetes: 30 (24%) in AFgroup and 28 (22.4%) in CG, Chi-squared 0.09, P<0.76, OR 1.09, 95%, and LV diastolic dysfunction (LVDD): 24 (19.2%) in AF-group and 20 (16%) in CG, Chi-squared 0.44, P<0.5, OR 1.25, 95%. In contrast to what was expected LV hypertrophy had a lower incidence of 59 (47.2%) in AF-group than in CG 84 (67.2%), Chi-squared 10.21, P<0.0014, OR 0.44, 95%. Conclusions. The prevalence of PAF in HPMW is not elevated, obesity and increased LA volume are strong determinants of PAF, not depending on age. LVDD, LV hypertrophy, and diabetes status seem not to play a relevant role as PAF determinants. [ABSTRACT FROM AUTHOR]

This is a challenging case of Wolff-Parkinson-White syndrome which was located in the right posteroseptum region. Patient had a previous unsuccessful attempt at ablation. It is often difficult to precisely locate this type of accessory pathway. A repeat procedure using 3D electroanatomic mapping, the electroanatomic geometry of the heart was created. The accessory pathway potential was identified and the accessory pathway was successfully ablated in minimum amount of time. In this case report showed that the advanced three-dimensional cardiac mapping system plays a very important role in guiding clinicians in order to precisely locate and safely ablate this type of challenging accessory pathway. [ABSTRACT FROM AUTHOR]

Copyright of Archives of the Turkish Society of Cardiology / Türk Kardiyoloji Derneği Arşivi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article describes the case of a male soccer player who had been screened by sport physicians for routine annual preseason medical clearance. It shows the patient's serial 12-lead electrocardiograms (ECGs) performed during his annual routine medical clearance. It discusses Wolff-Parkinson-White (WPW) pattern shown on the patient's ECG. The arguments for ECG screening in young athletes are also mentioned.

Background: Detecting high‐risk arrhythmia is important in diagnosing patients with palpitations. We compared the diagnostic accuracies of 7‐day patch‐type electrocardiographic (ECG) monitoring and 24‐h Holter monitoring for detecting significant arrhythmias in patients with palpitations. Methods: This was a single‐center prospective trial with 58 participants who presented with palpitations, chest pain or syncope. Outcomes were defined as the detection of any one of six arrhythmias, including supraventricular tachycardia (SVT), atrial fibrillation or atrial flutter lasting more than 30 s, pauses of more than 3 s, high‐degree atrioventricular block, ventricular tachycardia (VT) >3 beats, or polymorphic VT/ventricular fibrillation. The McNemar test for paired proportions was used to compare arrhythmia detection rates. Results: The overall arrhythmia detection rate was higher with 7‐day ECG patch monitoring than with 24‐h Holter monitoring (34.5% vs. 19.0%, p =.008). Compared with the use of 24‐h Holter monitors, the use of 7‐day ECG patch monitors was associated with higher detection of SVT (29.3% vs. 13.8%, p =.042). No serious adverse skin reactions were reported among the ECG patch‐monitored participants. Conclusions: The results suggest that a 7‐day patch‐type continuous ECG monitor is more effective for the detection of supraventricular tachycardia than is a 24‐h Holter monitor. However, the clinical significance of device detected arrhythmia should be consolidated. [ABSTRACT FROM AUTHOR]

Background: Radiofrequency ablation (RFA) is the standard method of treatment for tachyarrhythmias in school children, and it leads to complete recovery in children without structural heart disease. However, RFA in young children is limited by the risk of complications and unstudied remote effects of radiofrequency lesions. Objective: To present the experience of RFA of arrhythmias and the results of follow‐up of younger children. Materials and Methods: RFA procedures (n = 255) were performed in 209 children with arrhythmias from 0 to 7 years old. The arrhythmias were presented with atrioventricular reentry tachycardia with Wolff‐Parkinson‐White (WPW) syndrome (56%), atrial ectopic tachycardia (21.5%), atrioventricular nodal reentry tachycardia (4.8%), and ventricular arrhythmia (17.2%). Results: The overall effectiveness of RFA, considering the repeated procedures performed due to the primary ineffectiveness and recurrencies, was 94.7%. There was no mortality associated with RFA in patients, including young patients. All cases of "major" complications are associated with RFA of the left‐sided accessory pathway and tachycardia foci and are represented by the mitral valve damage in three patients (1.4%). Tachycardia and preexcitation recurred in 44 (21%) patients. There was a correlation between recurrences and parameters of RFA (odds ratio 0.894; 95% confidence interval: 0.804–0.994; p =.039). Reducing the maximum power of effective applications in our study increased the risk of recurrence. Conclusion: The use of the minimum effective parameters of RFA in children reduces the risk of complications, but increases arrhythmia recurrence rate. [ABSTRACT FROM AUTHOR]

Supraventricular tachycardia (SVT) is an abnormal rapid cardiac rhythm that involves atrial or atrioventricular node tissue from the His bundle or above. Paroxysmal SVT, a subset of supraventricular dysrhythmias, has three common types: atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, and atrial tachycardia. Presenting symptoms may include altered consciousness, chest pressure or discomfort, dyspnea, fatigue, lightheadedness, or palpitations. Diagnostic evaluation may be performed in the outpatient setting and includes a comprehensive history and physical examination, electrocardiography, and laboratory workup. Extended cardiac monitoring with a Holter monitor or event recorder may be needed to confirm the diagnosis. Acute management of paroxysmal SVT is similar across the various types and is best completed in the emergency department or hospital setting. In patients who are hemodynamically unstable, synchronized cardioversion is first-line management. In those who are hemodynamically stable, vagal maneuvers are first-line management, followed by stepwise medication management if ineffective. Beta blockers and/or calcium channel blockers may be used acutely or for long-term suppressive therapy. When evaluating patients for paroxysmal SVTs, clinicians should have a low threshold for referral to a cardiologist for electrophysiologic study and appropriate intervention such as ablation. Clinicians should use a patient-centered approach when formulating a long-term management plan for atrioventricular nodal reentrant tachycardia. Catheter ablation has a high success rate and is recommended as the first-line method for long-term management of recurrent, symptomatic paroxysmal SVT, including Wolff-Parkinson-White syndrome. (Am Fam Physician. 2023; 107(6): 631–641. Copyright © 2023 American Academy of Family Physicians.) Supraventricular tachycardia (SVT) is an abnormal rapid cardiac rhythm that involves atrial or atrioventricular node tissue from the His bundle or above. Paroxysmal SVT, a subset of supraventricular dysrhythmias, has three common types: atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, and atrial tachycardia. Presenting symptoms may include altered consciousness, chest pressure or discomfort, dyspnea, fatigue, lightheadedness, or palpitations. Diagnostic evaluation may be performed in the outpatient setting and includes a comprehensive history and physical examination, electrocardiography, and laboratory workup. Extended cardiac monitoring with a Holter monitor or event recorder may be needed to confirm the diagnosis. Acute management of paroxysmal SVT is similar across the various types and is best completed in the emergency department or hospital setting. In patients who are hemodynamically unstable, synchronized cardioversion is first-line management. In those who are hemodynamically stable, vagal maneuvers are first-line management, followed by stepwise medication management if ineffective. Beta blockers and/or calcium channel blockers may be used acutely or for long-term suppressive therapy. When evaluating patients for paroxysmal SVTs, clinicians should have a low threshold for referral to a cardiologist for electrophysiologic study and appropriate intervention such as ablation. Clinicians should use a patient-centered approach when formulating a long-term management plan for atrioventricular nodal reentrant tachycardia. Catheter ablation has a high success rate and is recommended as the first-line method for long-term management of recurrent, symptomatic paroxysmal SVT, including Wolff-Parkinson-White syndrome. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Beats 3, 5, 7, 9, and 11+ all had a similar morphology and preceding sinus P-waves with a constant PR interval, indicating that they were conducted sinus beats. Furthermore, the underlying sinus P-waves were unaltered by these regular ectopic beats, although they might have been buried in the QRS complex (beat 2) or the preceding T-wave (beat 11). A 54-year-old woman with a history of frequent symptomatic arrhythmias and Wolff-Parkinson-White syndrome status post prior catheter ablation procedures presented for evaluation of persistent symptoms. [Extracted from the article]

Sudden death (SD) in athletes is a potential avoidable dramatic scenario. When done regularly, cardiological evaluation increases the chances of diagnosing ventricular pre-excitation. Consequently, the following question arises: what is the real incidence of SD risk in athletes with Wolff-Parkinson-White (WPW) syndrome/pattern? This study included 84 consecutive patients diagnosed with WPW and was designed as a retrospective analysis of data acquired between 2011 and 2021 to answer this question. The patients were evaluated using a 12-lead electrocardiogram (ECG), echocardiography, stress test, and electrophysiological study (EPS). The SD risk linked to WPW was defined as ≥ 1 of the following: the anterograde effective refractory period (AERP) of the accessory pathway (AP) ≤ 250 ms, atrial fibrillation (AF) with the shortest RR pre-excited interval ≤ 250 ms, syncope during AF or atrioventricular reentry tachycardia. The athletes with WPW pattern (n=25) or syndrome (n=59) at risk of SD were identified and treated with radiofrequency ablation (RFA). The mean age was 19.83 (10–29) years; 66.6% were men. Seventeen athletes (n=17; 20.23%) were found with SD risk: 15 (n=15; 17.85%) in the WPW syndrome group and 2 (n=2; 2.38%) in the WPW pattern group. During the EPS, n=4 developed syncope: 1 during antidromic tachycardia and 3 during pre-excited AF. RFA was curative in 96.42% of cases. The EPS is mandatory to identify athletes with short AERP APs linked to an increased risk of SD. RFA is the intervention that settles the patients into a risk-free area, allowing resumption of sports shortly afterward.

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 (1) and the Pearson correlation coefficient were used. Results: A total of 364 patients were included (mean age 30 years, 57% male). The global 1 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 (1 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. [ABSTRACT FROM AUTHOR]

Nonischemic cardiomyopathies are a frequent occurrence. The understanding of the mechanism(s) and triggers of these cardiomyopathies have led to improvement and even recovery of left ventricular function. Although chronic right ventricular pacing-induced cardiomyopathy has been recognized for many years, left bundle branch block and pre-excitation have been recently identified as potential reversible causes of cardiomyopathy. These cardiomyopathies share a similar abnormal ventricular propagation that can be recognized by a wide QRS duration with left bundle branch block pattern; thus, we coined the term abnormal conduction-induced cardiomyopathies. Such abnormal propagation results in an abnormal contractility that can only be recognized by cardiac imaging as ventricular dyssynchrony. Appropriate diagnosis and treatment will not only lead to improved left ventricular ejection fraction and functional class, but may also reduce morbidity and mortality. This review presents an update of the mechanisms, prevalence, incidence, and risk factors, as well as their diagnosis and management, while highlighting current gaps of knowledge. [Display omitted] • Abnormal conduction-induced CM refers to LV systolic dysfunction caused by RVP, LBBB, or pre-excitation. In each case, ventricular dysfunction is reversible if properly treated. • Abnormal conduction-induced cardiomyopathies share a similar pattern of abnormal ventricular activation that can be recognized by a wide QRS duration and LBBB pattern resulting in abnormal contractility identified by cardiac imaging as ventricular dyssynchrony. • Appropriate diagnosis and treatment of these cardiomyopathies will not only improve LVEF and functional capacity but may also reduce mortality. [ABSTRACT FROM AUTHOR]

Background: Wolff–Parkinson–White syndrome is characterized by a short PR interval (delta-wave), long QRS complex, and the appearance of paroxysmal supraventricular tachycardia. Patients with Wolff–Parkinson–White syndrome usually have one accessory pathway, whereas cases with multiple accessory pathways are rare. Persistent left superior vena cava is a vascular anomaly in which the vein drains into the right atrium through the coronary sinus at the junction of the left internal jugular and subclavian veins due to abnormal development of the left cardinal vein. The simultaneous presence of multiple accessory pathways and persistent left superior vena cava has not been reported before. Case presentation: A 56-year-old Japanese man with a 5-year history of palpitations was referred for radiofrequency catheter ablation due to increased frequency of tachycardia episodes in the previous 2 months. Persistent left superior vena cava was confirmed by transthoracic echocardiography and computed tomography. An electrophysiological study revealed that the accessory pathways were located in the left lateral wall, anterolateral wall, and posteroseptal region. They were completely ablated with radiofrequency energy application. Conclusions: We reported an extremely rare case of a patient with multiple accessory pathways and persistent left superior vena cava. Our case may suggest a potential embryological relationship between the multiple accessory pathways and persistent left superior vena cava. [ABSTRACT FROM AUTHOR]

Copyright of Folia Cardiologica is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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. [ABSTRACT FROM AUTHOR]

A 16-year-old female with symptomatic Wolff-Parkinson-White (WPW) syndrome underwent catheter ablation of a left-sided lateral accessory pathway. The accessory pathway was eliminated with the first ablation lesion; however, the patient immediately developed complete heart block (CHB). At first, complete heart block was thought to be due to ablation of left atrial extension of the AV node, and pacemaker therapy was considered. However, careful ECG analysis revealed that the development of CHB was in fact due to bump injury to the AV node during transseptal catheterization. Conservative management allowed resolution of AV nodal conduction without need for a permanent pacemaker.

BACKGROUND:The Protein Kinase AMP-Activated Non-Catalytic Subunit Gamma 2 (PRKAG2) cardiac syndrome is characterized by glycogen accumulation in the cardiac tissue. The disease presents clinically with hypertrophic cardiomyopathy (HCM), and it is often associated with conduction abnormalities. CASE PRESENTATION:A 23 year-old female with history of Wolff-Parkinson-White (WPW) and HCM presented for evaluation after an episode of Non-ST Elevation Myocardial Infarction (NSTEMI). The patient was found to have severe coronary bridging on angiography and underwent an unroofing of the left anterior descending artery (LAD). Due to the constellation of symptoms, the patient underwent genetic testing and a cardiac muscle biopsy. Genetic testing was significant for an Arg302Gln mutation in the PRKAG2 gene. Cardiac tissue biopsy revealed significant myocyte hypertrophy and large vacuoles with glycogen stores. CONCLUSION:The pathologic and genetics findings of our patient are consistent with PRKAG2 syndrome. Patients presenting with conduction abnormalities and suspected HCM should be considered for genetic testing to identify possible underlying genetic etiologies.

Background: Prolonged mechanical ventilation (PMV) after pediatric cardiac surgery imposes a great burden on patients in terms of morbidity, mortality as well as financial costs. Ebstein anomaly (EA) is a rare congenital heart disease, and few studies have been conducted about PMV in this condition. This study aimed to establish a simple-to-use nomogram to predict the risk of PMV for EA children. Methods: The retrospective study included patients under 18 years who underwent corrective surgeries for EA from January 2009 to November 2021. PMV was defined as postoperative mechanical ventilation time longer than 24 hours. Through multivariable logistic regression, we identified and integrated the risk factors to develop a simple-to-use nomogram of PMV for EA children and internally validated it by bootstrapping. The calibration and discriminative ability of the nomogram were determined by calibration curve, Hosmer-Lemeshow goodness-of-fit test and receiver operating characteristic (ROC) curve. Results: Two hundred seventeen children were included in our study of which 44 (20.3%) were in the PMV group. After multivariable regression, we obtained five risk factors of PMV. The odds ratios and 95% confidence intervals (CI) were as follows: preoperative blood oxygen saturation, 0.876(0.805,0.953); cardiothoracic ratio, 3.007(1.107,8.169); Carpentier type, 4.644(2.065,10.445); cardiopulmonary bypass time, 1.014(1.005,1.023) and postoperative central venous pressure, 1.166(1.016,1.339). We integrated the five risk factors into a nomogram to predict the risk of PMV. The area under ROC curve of nomogram was 0.805 (95% CI, 0.725,0.885) and it also provided a good discriminative information with the corresponding Hosmer-Lemeshow p values > 0.05. Conclusions: We developed a nomogram by integrating five independent risk factors. The nomogram is a practical tool to early identify children at high-risk for PMV after EA corrective surgery. [ABSTRACT FROM AUTHOR]