scholarly journals Flecainide is a safe and effective treatment for pre-excited atrial fibrillation rapidly conducted to the ventricle in pregnant women: a case series

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Samuel Chauveau ◽  
Olivier Le Vavasseur ◽  
Elodie Morel ◽  
Arnaud Dulac ◽  
Philippe Chevalier
Keyword(s):  
Atrial Fibrillation ◽  
Pregnant Women ◽  
Accessory Pathway ◽  
Case Series ◽  
Mechanisms Of Action ◽  
Efficacy And Safety ◽  
Case Summary ◽  
Autonomic Changes ◽  
Treatment Mechanisms ◽  
Wolff Parkinson White Syndrome

Abstract Background Pregnancy is associated with an increased incidence of cardiac arrhythmias likely due to hormonal, haemodynamic, and autonomic changes. Yet, there is little data available regarding the efficacy and safety of anti-arrhythmic agents to prevent pre-excited atrial fibrillation (AF) in pregnant women. Case summary We report on three pregnant women who developed AF rapidly conducted to the ventricle through an overt accessory pathway as the first manifestation of Wolff–Parkinson–White syndrome. Discussion All patients were treated with flecainide with neither arrhythmias recurrence nor adverse events of the treatment. Mechanisms of action and clinical efficacy of flecainide are discussed.

scholarly journals Old stuff still trending. Use of propafenone as a safety net until catheter ablation in a patient with documented pre-excited atrial fibrillation and Wolff-Parkinson-White syndrome—a classic case report

2021 ◽  
Author(s):  
Dimitrios Karelas ◽  
John Papanikolaou ◽  
Charalampos Kossyvakis ◽  
Dimitrios Platogiannis
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Sudden Cardiac Death ◽  
Sinus Rhythm ◽  
Cardiac Death ◽  
Accessory Pathway ◽  
Safety Net ◽  
White Syndrome ◽  
Rr Interval ◽  
Wolff Parkinson White Syndrome

Abstract Background Atrial Fibrillation in Wolff-Parkinson-White syndrome may result in life-threateningly rapid antegrade conduction over a bypass tract, manifested by an irregular broad-complex (pre-excited) tachycardia that can degenerate to ventricular fibrillation. Shortest pre-excited RR interval below 250msec during atrial fibrillation predicts increased risk of sudden cardiac death. Case summary We report a case of a 43-year-old man with unremarkable cardiac history who presented due to sudden-onset feeling of palpitations and pre-syncope after strenuous lifting. Electrocardiography depicted fast pre-excited atrial fibrillation. The shortest pre-excited RR interval was estimated at 160msec, indicating an accessory pathway with short antegrade refractory period at risk for mediating sudden cardiac death. Direct current cardioversion restored sinus rhythm unraveling delta-waves. The patient was put on propafenone 450 mg/day having an uneventful clinical course. On day-10 post-admission, electrophysiological study induced rapid atrial fibrillation but the shortest pre-excited RR interval was substantially increased to 264msec. A left anterolateral accessory pathway was ablated. The patient remained symptom-free until his latest follow-up in the third month post-ablation without manifest pre-excitation on surface electrocardiogram. Discussion Treatment options of pre-excited atrial fibrillation include anti-arrhythmic agents but mainly electrical cardioversion. Cardioversion can safely restore sinus rhythm, while use of anti-arrhythmics often requires ICU monitoring due to risk of QT prolongation. Catheter ablation is the mainstay of therapy for symptomatic patients. Our rare report highlights the direct impact of propafenone on prolonging the refractoriness of the accessory pathway, effectively and safely, and reappraises propafenone’s worthiness as a protective measure following pre-excited atrial fibrillation episode until ablation.

scholarly journals Transient appearance of Brugada-like Type 1 electrocardiogram pattern immediately after biphasic synchronized electrical cardioversion for atrial fibrillation: a case series

2019 ◽  
Author(s):  
Khalid A S Abdalla ◽  
Antonio Sorgente ◽  
Pedro Brugada
Keyword(s):  
Atrial Fibrillation ◽  
Safety Issue ◽  
Case Series ◽  
Electrical Cardioversion ◽  
Common Finding ◽  
St Segment Elevation ◽  
Case Summary ◽  
St Segment ◽  
Number Of Patients

Abstract Background ST-segment deviation post-electrical cardioversion is a common finding amongst a significant number of patients. However, the mechanism by which this phenomenon occurs and its clinical implications are not fully understood. Case summary Four patients presented to our department with complaints of palpitations. They were found to have atrial fibrillation and were cardioverted using a synchronized direct current shock at 200 J. However, their telemetry immediately after the shock showed transiently an ST-segment elevation resembling Brugada Type 1 pattern. All telemetries normalized within 6 s from cardioversion. Discussion Through this report, we aim to raise mild concern about a possible safety issue related to synchronized electrical cardioversion with electrodes positioned in an anteroposterior fashion. Also, we try to give a pathophysiological explanation to this finding on the base of the knowledge accumulated through the years on Brugada syndrome.

Diagnosis and management of arrhythmias associated with Wolff-Parkinson-White syndrome

1994 ◽  
Vol 14 (3) ◽  
pp. 30-39 ◽  
Author(s):  
MB Conover
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Treatment ◽  
Accessory Pathway ◽  
P Wave ◽  
Av Node ◽  
Wpw Syndrome ◽  
Reentry Tachycardia ◽  
Fast Pathway ◽  
Wolff Parkinson White Syndrome

Because of the emergency nature of the arrhythmias associated with WPW syndrome, nurses are often called upon for diagnosis and intervention in critical settings. In such cases the nurse's understanding of mechanisms, ECG recognition, and emergency treatment guarantees the patient the best possible outcome, not only in the critical setting, but in the long term as well. The most common arrhythmias of WPW syndrome are PSVT and atrial fibrillation. In PSVT a differential diagnosis is made on the ECG between (1) CMT using the AV node anterogradely and an accessory pathway retrogradely and (2) AV nodal reentry tachycardia. Helpful clues are location of the P' wave, presence of QRS alternans, the initiating P'R interval, and presence of aberrancy. Atrial fibrillation with an accessory pathway has the morphology of VT but is differentiated because the rhythm is irregular and the rate is more than 200 beats per minute. Emergency treatment consists of blocking the accessory pathway with procainamide. Emergency treatment for both types of PSVT consists of breaking the reentry circuit at the AV node (eg, vagal maneuver, adenosine, or verapamil). Procainamide can also be used to block the retrograde fast pathway in the AV node and to terminate CMT by blocking the accessory pathway. Symptomatic patients with accessory pathways are referred for evaluation and possible radio-frequency ablation.

scholarly journals Cryoablation of a Mahaim Epicardial Accessory Pathway Inside Coronary Sinus Using an 8-mm Catheter

2021 ◽  
pp. 79-83
Author(s):  
Bruno Pereira Valdigem ◽  
Nilton José Carneiro da Silva ◽  
Rogerio Braga Andalaft ◽  
Carla Almeida ◽  
Nilson Araujo Junior ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Sinus ◽  
Accessory Pathway ◽  
Review Literature ◽  
Atrial Fibrillation Ablation ◽  
Low Flow ◽  
White Syndrome ◽  
Ablation Technique ◽  
Wolff Parkinson White Syndrome

Cyoablation is a ablation technique underutilized except in parahissian pathways and atrial fibrillation ablation. Ablation inside venous coronary sinus remains a dreaded incursion, and cryoablation is rarely used. We present the case of a 43 YO female who had a recurrent wolff parkinson white syndrome due to an epicardial pathway inside the coronary sinus successfully treated with a large bore(8mm) cryocatheter. We also review literature and describe the advantages and similar reports of use of cryo in low flow recesses inside the heart.

scholarly journals Progressive Facilitation of Antegrade Conduction via an Accessory Pathway in a Patient with Wolff-Parkinson-White Syndrome and Permanent Atrial Fibrillation

2005 ◽  
Vol 44 (12) ◽  
pp. 1264-1268
Author(s):  
Naohiko TAKAHASHI ◽  
Tatsuhiko OOIE ◽  
Mikiko NAKAGAWA ◽  
Masahide HARA ◽  
Tetsunori SAIKAWA ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Accessory Pathway ◽  
White Syndrome ◽  
Permanent Atrial Fibrillation ◽  
Wolff Parkinson White Syndrome
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