Wolff Parkinson White syndrome: Validation of an algorithm for identifying accessory pathway in children

Abstract Background This is a rare and challenging case of Wolff–Parkinson–White syndrome due to a posteroseptal accessory pathway located in the coronary sinus diverticulum. It is often difficult to precisely locate this type of accessory pathway, and the ablation procedure could be associated with collateral damage to the neighbouring coronary arteries. Case Presentation The patient was a 49-year-old female with Wolff–Parkinson–White syndrome who was referred for catheter ablation. She had had a previous unsuccessful attempt at ablation and had remained symptomatic despite drug therapy. The pre-procedural cardiac computed tomography scan revealed the presence of a diverticulum in the proximal coronary sinus. Using an advanced three-dimensional cardiac mapping system, the electroanatomic map of the diverticulum was created. The accessory pathway potential was identified within the diverticulum preceding the ventricular insertion. The accessory pathway was then successfully ablated using radiofrequency energy. Conclusion We have demonstrated 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.

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Successful catheter ablation by radiofrequency energy of posteroseptal accessory pathway in a patient with drug refractory Wolff--Parkinson--White syndrome

European Heart Journal ◽

10.1093/eurheartj/12.12.1321 ◽

1991 ◽

Vol 12 (12) ◽

pp. 1321-1325

Author(s):

P. DELISE ◽

A. BONSO ◽

A. RAVIELE ◽

R. CAZZIN ◽

F. DI PEDE ◽

...

Keyword(s):

Catheter Ablation ◽

Accessory Pathway ◽

Radiofrequency Energy ◽

White Syndrome ◽

Posteroseptal Accessory Pathway ◽

Wolff Parkinson White Syndrome

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Flecainide-induced incessant orthodromic atrioventricular reentrant tachycardia in Wolff-Parkinson-White syndrome: Uneven depression of accessory pathway conduction

HeartRhythm Case Reports ◽

10.1016/j.hrcr.2016.08.001 ◽

2016 ◽

Vol 2 (6) ◽

pp. 506-510 ◽

Cited By ~ 1

Author(s):

Oscar A. Pellizzón ◽

Manlio F. Márquez ◽

Mario D. González ◽

Sebastián Nannini ◽

Rodolfo Leiva ◽

...

Keyword(s):

Accessory Pathway ◽

Reentrant Tachycardia ◽

White Syndrome ◽

Atrioventricular Reentrant Tachycardia ◽

Wolff Parkinson White Syndrome

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MODELING OF WOLFF–PARKINSON–WHITE SYNDROME

International Journal of Bifurcation and Chaos ◽

10.1142/s0218127403008922 ◽

2003 ◽

Vol 13 (12) ◽

pp. 3827-3834

Author(s):

ROBERT HINCH

Keyword(s):

Asymptotic Analysis ◽

Ion Channel ◽

Sodium Channel ◽

Channel Model ◽

Accessory Pathway ◽

Simplified Model ◽

Channel Kinetics ◽

White Syndrome ◽

Channel Density ◽

Wolff Parkinson White Syndrome

Wolff–Parkinson–White syndrome is a disease where an arrhythmia is caused by the ventricles being electrically excited by an additional accessory pathway that links the atria to the ventricles. The spread of the activation wave from this pathway to the ventricles is modeled using a simplified model of Hodgkin–Huxley sodium channel kinetics, in a two ion-channel model. The model is investigated both analytically (using an asymptotic analysis) and numerically, and both methods are shown to give the same result. It is found that for a given width of the accessory pathway, there is a critical sodium channel density needed for the activation wave to spread from the pathway to the tissue. This result provides an explanation for the success of class-I anti-arrhythmic drugs in treating Wolff–Parkinson–White syndrome.

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Reversal of systolic dysfunction in noncompaction and Wolff-Parkinson-White syndrome after accessory pathway ablation

Journal of Cardiology Cases ◽

10.1016/j.jccase.2021.05.001 ◽

2021 ◽

Author(s):

Katrin Rezkalla ◽

Edmund Gatterer ◽

Matthias Hasun ◽

Johannes Huber ◽

Claudia Stöllberger ◽

...

Keyword(s):

Systolic Dysfunction ◽

Accessory Pathway ◽

White Syndrome ◽

Wolff Parkinson White Syndrome

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Sevoflurane Has No Effect on Sinoatrial Node Function or on Normal Atrioventricular and Accessory Pathway Conduction in Wolff-Parkinson-White Syndrome during Alfentanil/Midazolam Anesthesia

Anesthesiology ◽

10.1097/00000542-199901000-00010 ◽

1999 ◽

Vol 90 (1) ◽

pp. 60-65 ◽

Cited By ~ 33

Author(s):

Michael D. Sharpe ◽

Daniel J. Cuillerier ◽

John K. Lee ◽

Magdi Basta ◽

Andrew D. Krahn ◽

...

Keyword(s):

Cycle Length ◽

Sinoatrial Node ◽

Sinus Node ◽

Accessory Pathway ◽

Atrioventricular Node ◽

Conduction Time ◽

White Syndrome ◽

The Right ◽

Ablative Procedures ◽

Wolff Parkinson White Syndrome

Background The effects of sevoflurane on the electrophysiologic properties of the human heart are unknown. This study evaluated the effects of sevoflurane on the electrophysiologic properties of the normal atrioventricular conduction system, and on the accessory pathways in patients with Wolff-Parkinson-White syndrome, to determine its suitability as an anesthetic agent for patients undergoing ablative procedures. Methods Fifteen patients with Wolff-Parkinson-White syndrome undergoing elective radiofrequency catheter ablation were studied. Anesthesia was induced with alfentanil (20-50 microg/kg) and midazolam (0.15 mg/kg), and vecuronium (20 mg) and maintained with alfentanil (0.5 to 2 microg x kg(-1) x min(-1)) and midazolam (1 or 2 mg every 10-15 min, as required). An electrophysiologic study measured the effective refractory period of the right atrium, atrioventricular node, and accessory pathway; the shortest conducted cycle length of the atrioventricular node and accessory pathway during atrial pacing; the effective refractory period of the right ventricle and accessory pathway; and the shortest retrograde conducted cycle length of the accessory pathway during ventricular pacing. Parameters of sinoatrial node function included sinus node recovery time, corrected sinus node recovery time, and sinoatrial conduction time. Intraatrial conduction time and the atrial-His interval were also measured. Characteristics of induced reciprocating tachycardia, including cycle length, atrial-His, His-ventricular, and ventriculoatrial intervals, also were measured. Sevoflurane was administered to achieve an end-tidal concentration of 2% (1 minimum alveolar concentration), and the study measurements were repeated. Results Sevoflurane had no effect on the electrophysiologic parameters of conduction in the normal atrioventricular conduction system or accessory pathway, or during reciprocating tachycardia. However, sevoflurane caused a statistically significant reduction in the sinoatrial conduction time and atrial-His interval but these changes were not clinically important. All accessory pathways were successfully identified and ablated. Conclusions Sevoflurane had no effect on the electrophysiologic nature of the normal atrioventricular or accessory pathway and no clinically important effect on sinoatrial node activity. It is therefore a suitable anesthetic agent for patients undergoing ablative procedures.

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