Difficulties with Invasive Risk Stratification Performed Under Anesthesia in Pediatric Wolff-Parkinson-White Syndrome
Children with Wolff-Parkinson-White Syndrome (WPW) are at risk for sudden death. The gold standard for risk stratification in this population is the shortest pre-excited RR interval during atrial fibrillation (SPERRI).
Pacing and Clinical Electrophysiology, Volume 0, Issue ja, -Not available-.
We present a case of a young asymptomatic patient who developed acute atrial fibrillation with antegrade conduction over the atrioventricular bypass tract and very high ventricular rate after accidental low voltage electric injury, which was reverted successfully by DC shock. PMID: 31011403 [PubMed]
CONCLUSIONS This is the first study documenting the presence of silent cerebral infarcts after WPW ablation. Further investigations are needed to evaluate the risk of silent cerebral infarcts associated with L-AP ablation. PMID: 30778023 [PubMed - in process]
Fasciculoventricular fibers (FVFs) are responsible for 1-5% of cases of asymptomatic pre-excitation on surface electrocardiogram (ECG). Unlike ventricular pre-excitation seen in Wolff-Parkinson-White (WPW) syndrome, FVFs are not associated with sudden cardiac death from pre-excited atrial fibrillation.
Conclusions Atrial fibrillation, as well as its conduction to the ventricles, can be caused by adenosine. Rapid ventricular response in children with Wolff-Parkinson-White syndrome is more frequent than previously believed. A patient history of atrial fibrillation is a contraindication for cardioversion with adenosine and needs to be assessed in children with reentry tachycardia. High-risk patients may potentially profit from prophylactic comedication with antiarrhythmic agents, such as flecainide, ibutilide, or vernakalant, before adenosine administration.
CONCLUSIONS: Cardiac involvement in m.3243A>G carriers has been only rarely systematically studied, which is perhaps why the incidence of cardiac diseases in MELAS is lower than would be expected. Myocardial abnormalities are much more frequent than arrhythmias or conduction defects. All symptomatic and asymptomatic m.3243A>G carriers should be systematically investigated for cardiac disease. PMID: 30128910 [PubMed - as supplied by publisher]
To assess the mid-term mortality and risk of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HC) and Wolff-Parkinson-White (WPW) syndrome, 40 patients with HC and WPW were enrolled in our center between 2010 and 2017. An age- and sex-matched comparison cohort of patients with HC without WPW (N=160) was generated from the same center. The clinical profile and outcomes were assessed. Of 40 patients with WPW, 28 underwent accessory pathway (AP) elimination. Two patients (7%) had failed in AP elimination.
Catheter ablation (CA) of accessory atrioventricular pathways by radiofrequency current has been introduced in the early nineties . According to current guidelines, CA is effective and safe and is recommended in patients affected by Wolff-Parkinson-White syndrome (overt ventricular pre-excitation and atrio-ventricular re-entrant tachycardia or atrial fibrillation) and should be considered in asymptomatic patients with high-risk pre-excitation [2, 3]. These same guidelines, however, do not make the call regarding the best approach for CA of left sided pathways.
Our understanding of Wolff-Parkinson-White (WPW) syndrome has evolved significantly since its initial description a century ago, including the mechanisms that underlie the association with supraventricular tachycardia, atrial fibrillation, and sudden cardiac death. Although WPW syndrome is a frequently encountered congenital abnormality, incidence patterns for the most part are noninherited. Rare familial WPW syndrome has been associated with specific gene mutations in the PRKAG2 gene. Field et al (DOI: https://doi.org/10.1016/j.hrcr.2018.01.013) presented an interesting case series of identical twins who developed p...
Conclusions Our study revealed an unexpected prevalence of CV abnormalities among Olympic athletes, including a small, but not negligible proportion of pathological conditions at risk. This observation suggests that Olympic athletes, despite the absence of symptoms or astonishing performances, are not immune from CV disorders and might be exposed to unforeseen high-risk during sport activity.