Anaesthetic challenges in a patient with Wolff-Parkinson-White (WPW) syndrome for orchidectomy

Tat Boon Yeap; Ming Kai Teah; Shankaran Thevarajah; Salamah Azerai

doi:10.1136/bcr-2020-241176

Anaesthetic challenges in a patient with Wolff-Parkinson-White (WPW) syndrome for orchidectomy

BMJ Case Reports ◽

10.1136/bcr-2020-241176 ◽

2021 ◽

Vol 14 (3) ◽

pp. e241176

Author(s):

Tat Boon Yeap ◽

Ming Kai Teah ◽

Shankaran Thevarajah ◽

Salamah Azerai

Keyword(s):

Cardiac Conduction ◽

Cardiac Events ◽

Wpw Syndrome ◽

Conduction Disorder

Wolff-Parkinson-White (WPW) syndrome is an extremely rare congenital cardiac conduction disorder. It is due to an aberrant pathway between the atrium and ventricle. This manuscript entails a man with an underlying WPW who was posted for an elective orchidectomy. We discussed the important perioperative precautions to prevent the precipitation of acute cardiac events.

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Wolff-Parkinson-White Syndrome

AACN Advanced Critical Care ◽

10.4037/15597768-1992-1023 ◽

1992 ◽

Vol 3 (1) ◽

pp. 180-189 ◽

Cited By ~ 1

Author(s):

Joanne Hughes Morscher

Keyword(s):

Sudden Cardiac Arrest ◽

Cardiac Conduction ◽

Treatment Modalities ◽

White Syndrome ◽

Wpw Syndrome ◽

Life Threatening ◽

History Of ◽

Diagnostic Modalities ◽

Supraventricular Tachycardias ◽

Wolff Parkinson White Syndrome

Wolff-Parkinson-White (WPW) syndrome is a cardiac conduction disorder that presents with potentially life-threatening consequences. Wolff-Parkinson-White syndrome-induced dysrhythmias account for 20% of all supraventricular tachycardias that occur in the general population. Clinical presentations range from no symptoms to a sudden cardiac arrest. The risk of sudden death is always present with WPW syndrome, and it is the motivating force in the evaluation and treatment of this syndrome. Current diagnostic modalities are accurate in identifying patients with WPW syndrome, but lack the sensitivity to predict sudden cardiac death. This article reviews the history of WPW syndrome, as well as its general characteristics, diagnostic criteria, treatment modalities, and nursing implications

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Cardiac Conduction Disorders as Markers of Cardiac Events in Myotonic Dystrophy Type 1

Journal of the American Heart Association ◽

10.1161/jaha.119.015709 ◽

2020 ◽

Vol 9 (17) ◽

Cited By ~ 1

Author(s):

Hideki Itoh ◽

Takashi Hisamatsu ◽

Takuhisa Tamura ◽

Kazuhiko Segawa ◽

Toshiaki Takahashi ◽

...

Keyword(s):

Sudden Death ◽

Myotonic Dystrophy ◽

Cardiac Conduction ◽

Myotonic Dystrophy Type 1 ◽

Myotonic Dystrophy Type ◽

Cardiac Events ◽

Conduction Disorders ◽

Qrs Duration

Background Myotonic dystrophy type 1 involves cardiac conduction disorders. Cardiac conduction disease can cause fatal arrhythmias or sudden death in patients with myotonic dystrophy type 1. Methods and Results This study enrolled 506 patients with myotonic dystrophy type 1 (aged ≥15 years; >50 cytosine‐thymine‐guanine repeats) and was treated in 9 Japanese hospitals for neuromuscular diseases from January 2006 to August 2016. We investigated genetic and clinical backgrounds including health care, activities of daily living, dietary intake, cardiac involvement, and respiratory involvement during follow‐up. The cause of death or the occurrence of composite cardiac events (ie, ventricular arrhythmias, advanced atrioventricular blocks, and device implantations) were evaluated as significant outcomes. During a median follow‐up period of 87 months (Q1–Q3, 37–138 months), 71 patients expired. In the univariate analysis, pacemaker implantations (hazard ratio [HR], 4.35; 95% CI, 1.22–15.50) were associated with sudden death. In contrast, PQ interval ≥240 ms, QRS duration ≥120 ms, nutrition, or respiratory failure were not associated with the incidence of sudden death. The multivariable analysis revealed that a PQ interval ≥240 ms (HR, 2.79; 95% CI, 1.9–7.19, P <0.05) or QRS duration ≥120 ms (HR, 9.41; 95% CI, 2.62–33.77, P < 0.01) were independent factors associated with a higher occurrence of cardiac events than those observed with a PQ interval <240 ms or QRS duration <120 ms; these cardiac conduction parameters were not related to sudden death. Conclusions Cardiac conduction disorders are independent markers associated with cardiac events. Further investigation on the prediction of occurrence of sudden death is warranted.

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Generation of two iPSC lines (FAMRCi004-A and FAMRCi004-B) from patient with familial progressive cardiac conduction disorder carrying genetic variant DSP p.His1684Arg.

Stem Cell Research ◽

10.1016/j.scr.2020.101720 ◽

2020 ◽

Vol 43 ◽

pp. 101720

Author(s):

Aleksandr Khudiakov ◽

Kseniya Perepelina ◽

Polina Klauzen ◽

Anna Zlotina ◽

Konstantin Gusev ◽

...

Keyword(s):

Genetic Variant ◽

Cardiac Conduction ◽

Conduction Disorder

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Abstract 16603: Appropriate Timing of Pacemaker Implantation in Patients With Wild-Type and Variant Amyloidogenic Transthyretin Cardiac Amyloidosis

Circulation ◽

10.1161/circ.142.suppl_3.16603 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Yusei Kawahara ◽

Miwa Ito ◽

Tadashi Hoshiyama ◽

Hisanori Kanazawa ◽

Kenichi Tsujita

Keyword(s):

Cardiac Amyloidosis ◽

Pacemaker Implantation ◽

The Other ◽

Cardiac Conduction ◽

Wild Type ◽

Conduction Disorders ◽

Other Hand ◽

Conduction Disorder ◽

Second Degree

Background and Objectives: It has been shown that cardiac conduction disorders can be seen in patients with wild-type amyloidogenic transthyretin (ATTRwt) and variant ATTR (ATTRv) cardiac amyloidosis. However, its appropriate timing of pacemaker implantation has not been clarified yet. Methods and Results: The consecutive 100 patients with ATTRwt cardiac amyloidosis who diagnosed by myocardium biopsy and/or technetium-99m-pyrophosphate scintigraphy and 62 patients with ATTRv cardiac amyloidosis who diagnosed by means of genetic screening were included in this study. In patients with ATTRwt cardiac amyloidosis, 21 patients have normal conduction at the time of diagnosis. However, conduction disorder had seen in only 5 patient (first degree atrioventricular block (AVB); 4 patients, complete AVB; 1 patients) and only one patient underwent cardiac implantable electric device (CIED) implantation during follow-up period. On the other hand, in patients with ATTRv cardiac amyloidosis, 36 patients have normal conduction at the time of diagnosis. However, conduction disorder had seen in 13 patient (first degree AVB; 8 patients, second degree AVB; 3 patients, trifascicular block; 1 patients, complete AVB; 1 patients) (5/21 vs 13/36, p=0.335) and 6 patients underwent CIED implantation during follow-up period (1/21 vs 6/36, p=0.186). Furthermore, in ATTRwt cardiac amyloidosis, 10 patients (first degree AVB; 2 patients, second degree AVB; 1 patient, trifascicular block; 7 patients) had underwent CIED implantation because of cardiac conduction disorders and/or prevention of sudden cardiac death. However, only 4 patients with trifascicular block progressed to complete AVB.On the other hand, In ATTRv cardiac amyloidosis, 14 patients (first degree AVB; 2 patients, second degree AVB; 4 patient, trifascicular block; 8 patients) had underwent CIED implantation for same reason. However, only 3 patients with trifascicular block progressed to complete AVB. Conclusions: Patients with ATTRv cardiac amyloidosis were more likely to progress conduction disorders than those with ATTRwt cardiac amyloidosis. However, prophylactic pacemaker implantation might had not need in both ATTRwt and ATTRv patients with first or second degree AVB.

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Use of radiotelemetry to assess perinatal cardiac function in the ovine fetus and newborn

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00078.2017 ◽

2017 ◽

Vol 313 (6) ◽

pp. R660-R668 ◽

Cited By ~ 1

Author(s):

A. Antolic ◽

C. E. Wood ◽

M. Keller-Wood

Keyword(s):

Cardiac Function ◽

New Technologies ◽

Perinatal Period ◽

Aortic Pressure ◽

Late Gestation ◽

Cardiac Conduction ◽

Fetal Life ◽

Cardiac Events ◽

Fetal Ecg ◽

Ovine Fetus

The late gestation fetal ECG (fECG) has traditionally been difficult to characterize due to the low fECG signal relative to high maternal noise. Although new technologies have improved the feasibility of its acquisition and separation, little is known about its development in late gestation, a period in which the fetal heart undergoes extensive maturational changes. Here, we describe a method for the chronic implantation of radiotelemetry devices into late gestation ovine fetuses to characterize parameters of the fECG following surgery, throughout late gestation, and in the perinatal period. We found no significant changes in mean aortic pressure (MAP), heart rate (HR), or ECG in the 5 days following implantation; however, HR decreased in the first 24 h following the end of surgery, with associated increases in RR, PR, and QRS intervals. Over the last 14 days of fetal life, fetal MAP significantly increased, and HR significantly decreased, as expected. MAP and HR increased as labor progressed. Although there were no significant changes over time in the ECG during late gestation, the duration of the PR interval initially decreased and then increased as birth approached. These results indicate that although critical maturational changes occur in the late gestation fetal myocardium, the mechanisms that control the cardiac conduction are relatively mature in late gestation. The study demonstrates that radiotelemetry can be successfully used to assess fetal cardiac function, in particular conduction, through the process of labor and delivery, and may therefore be a useful tool for study of peripartum cardiac events.

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Wolff-Parkinson-White syndrome and noncompaction in Leber’s hereditary optic neuropathy due to the variant m.3460G>A

Journal of International Medical Research ◽

10.1177/0300060518765846 ◽

2018 ◽

Vol 46 (5) ◽

pp. 2054-2060 ◽

Cited By ~ 2

Author(s):

Josef Finsterer ◽

Claudia Stollberger ◽

Edmund Gatterer

Keyword(s):

Visual Acuity ◽

Optic Neuropathy ◽

Systolic Function ◽

Cardiac Conduction ◽

Leber’S Hereditary Optic Neuropathy ◽

Leber's Hereditary Optic Neuropathy ◽

Wpw Syndrome ◽

Myocardial Thickening ◽

Ventricular Tachycardias ◽

Hereditary Optic Neuropathy

This report describes a 66-year-old Caucasian male who acutely developed severe, bilateral impairment of visual acuity at 24 years of age. Leber’s hereditary optic neuropathy (LHON) was suspected but the diagnosis was not genetically confirmed until the age of 49 years when the primary LHON mutation m.3460G>A was detected. Since onset, visual acuity had slightly improved. The family history was positive for LHON (brother, two sisters of mother, female cousin) and genetically confirmed in his brother and one aunt. Since the age of 65 years, he had experienced recurrent vertigo. His cardiological history was positive for arterial hypertension, noncompaction, myocardial thickening, intermittent right bundle-branch-block (RBBB) and Wolff-Parkinson-White (WPW) syndrome. In addition to LHON, he presented with polyneuropathy, hyperCKaemia, carotid artery occlusion, and a history of stroke. Cardiological investigations at 66 years of age revealed mildly reduced systolic function, enlarged atria, and nonsustained ventricular tachycardias. He underwent an electrophysiological investigation, but radiofrequency ablation was ruled out due to a ‘bizarre’ cardiac conduction system. Instead, an implantable cardioverter defibrillator was proposed but refused by the patient. Since the vertigo did not resolve it was attributed to polyneuropathy. This case demonstrates that LHON may be associated with noncompaction, myocardial thickening, reduced systolic function, enlarged atria, RBBB, WPW syndrome and nonsustained ventricular tachycardias. WPW syndrome in LHON may require invasive antiarrhythmic treatment.

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