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INTRODUCTION: In this case report we will describe a Japanese military U-125 Pilot who was found to have WPW syndrome during his annual aviation medical examination and returned to flight duties through catheter ablation. BACKGROUND: Wolff-Parkinson-White syndrome, or WPW syndrome, is a cardiac arrhythmia characterized by an abnormal electrical pathway in the heart. Normally, the heart's contractions are regulated by a specific pathway, but in WPW syndrome, an abnormal pathway known as an "accessory pathway" exists. This can lead to rapid and irregular heartbeats. One specific arrhythmia associated with WPW syndrome is called "pseudo ventricular tachycardia." In this condition, the abnormal pathway allows the ventricles to be excited prematurely, resulting in a faster heartbeat than usual. This pseudo ventricular tachycardia is distinct from regular ventricular tachycardia. When pseudo ventricular tachycardia occurs, the heart rate becomes very fast, and the rhythm becomes irregular. Symptoms may include dizziness, shortness of breath, and chest discomfort. In severe cases, loss of consciousness can occur. CASE PRESENTATION: The pilot was 46 years old when an electrocardiogram during an aviation medical examination showed ventricular tachycardia-like waveforms, and he was suspended from flight duties. He underwent cardiac electrophysiology testing, was diagnosed with WPW syndrome, and underwent catheter ablation. One month after the ablation, he underwent echocardiography, Holter ECG, and exercise stress ECG, none of which showed arrhythmia. Aeromedical Evaluation Board allowed him to return to flight duties on conditions. No further problematic arrhythmias were found. Another Aeromedical Evaluation Board was conducted, with arrythmia mitigated, he was returned to fly. DISCUSSION: At JASDF, the Aeromedical Evaluation Board determines whether a pilot who fails an aviation medical examination is allowed to return to flight duties. Ablation for WPW syndrome generally has a high success rate. However, in some patients with multiple abnormal conduction pathways, other conduction pathways may cause recurrence, so it is necessary to define appropriate evaluation criteria for each patient with WPW syndrome. This presentation will discuss the flight conditions imposed on pilots and the measures used by Japan, Iraq, and the US military for various arrhythmias. Learning Objectives 1. The audience will learn about the presentation, diagnosis, and/or treatment of an interesting Aerospace Medicine case. 2. The audience will learn about the similarities and differences in medical standards and pilot medical clearances for civilian, US and foreign military aviation professionals. [ABSTRACT FROM AUTHOR]

Background: While β-blockers can be effective in controlling tachyarrhythmias after pediatric cardiac surgery, a negative inotropic influence sometimes complicates their use. Landiolol hydrochloride is a novel, ultra-short-acting β-blocker recently developed in Japan. The drug has higher β1:β2 selectivity ratio and a less negative inotropic effect. This study retrospectively evaluates the efficacy and safety of landiolol in the management of tachyarrhythmias after pediatric cardiac surgery. Methods: A retrospective analysis was performed on 312 consecutive patients undergoing surgery for congenital heart disease. Twelve patients were treated with landiolol for critical tachyarrhythmia. The mean age of patients was 28.7 ± 10.6 months. Five junctional ectopic tachycardia, 2 atrial flutters, 1 paroxysmal supraventricular tachycardia, 1 atrial fibrillation, 1 atrioventricular reciprocating tachycardia with Wolff-Parkinson-White syndrome and 2 excessive sinus tachycardia were treated. Results: The mean loading and maintenance doses were 11.3 ± 4.0 and 6.8 ± 0.9 μg/kg per minute, respectively. Rate control was achieved in all patients. Landiolol reduced the heart rate from 169.7 ± 11.4 to 127.7 ± 7.5 beats per minute (p < 0.05) while blood pressure did not significantly change. Tachyarrhythmias were converted to sinus rhythm in 70.0% of the cases and the average time needed to achieve heart rate reduction was 2.3 ± 0.5 hours. Conclusions: Landiolol was efficacious in treating tachyarrhythmia in pediatric cardiac surgery. The desired negative chronotropic effect was achieved without significant hemodynamic compromise. The ultra-short half-life of landiolol provided rapid dose manipulation. This study suggests that landiolol is a promising option for the management of postoperative tachyarrhythmias in pediatric patients. [ABSTRACT FROM AUTHOR]

Unlabelled: In the period 1985 to 1993, a total of 802 school-aged children (284 first-graders and 518 seventh-graders) were referred to our hospital for further evaluation of electrocardiographic abnormalities. Among them, 57 (male 24 and female 33) children were confirmed as having Wolff-Parkinson-White (WPW) syndrome based on the findings of 12-lead surface electrocardiograms (ECG). According to Lindsay's criteria, the locations of the accessory pathways were as follows: Left-lateral in 10 (18%), left-posterior in 2 (4%), right-free-wall in 28 (49%), anterior-septum in 13 (23%) and posterior-septum in 3 (5%). One 12-y-old girl had multiple accessory pathways. Six patients had associated diseases: Ebstein's anomaly in 4, epilepsy in 1 and mental retardation with scoliosis in 1. Follow-up periods ranged from 2.0 to 13.0 y (mean +/- SD: 8.0 +/- 3.3 y) for 23 first-graders with WPW syndrome, and from 2.0 to 13.0y (mean +/- SD: 7.3 +/- 4.2y) for 34 seventh-graders, respectively. Initially, 5 children had at least one episode of supraventricular tachycardia (SVT) by history and 6 children developed SVT during the follow-up. One girl with multiple accessory pathways and recurrent SVT required long-term drug therapy.Conclusions: The outcome of children with WPW syndrome detected by a heart screening program at school was favorable. Our 8 y follow-up of 57 children with WPW syndrome will serve as additional information concerning the indication of radio-frequency catheter ablation therapy for WPW syndrome in children. [ABSTRACT FROM AUTHOR]

Investigates changes in ventricular pre-excitation during Yamanashi, Japan school medical examinations, which included an electrocardiogram. Diagnosis of ventricular pre-excitation; Comparison of prevalence.