scholarly journals Sudden Cardiac Death: The Most Feared but Potentially Preventable Presentation of Wolff-Parkinson-White Syndrome

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Ana Rita Pereira ◽  
Alexandra Briosa ◽  
Rita Miranda ◽  
Sofia Sequeira Almeida ◽  
Luís Brandão ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Life Support ◽  
Electrophysiological Study ◽  
Accessory Pathway ◽  
Haemodynamic Instability ◽  
White Syndrome ◽  
Asymptomatic Patients ◽  
Wolff Parkinson White Syndrome

Background. Wolff-Parkinson-White syndrome is an uncommon cardiac disorder characterized by the presence of one or more accessory pathways that predispose patients to frequent episodes of arrhythmias. The prognosis is usually good, but there is a lifetime risk of malignant arrhythmias and sudden cardiac death. Case Summary. A 25-year-old male presented a witnessed out-of-hospital cardiac arrest with ventricular fibrillation rhythm. Due to rapid initiation of prehospital advanced life support, return of spontaneous circulation was observed. During the transport to the hospital, an irregular wide complex tachycardia suggestive of preexcited atrial fibrillation with haemodynamic instability was also observed and a synchronized shock was applied. Baseline 12-lead electrocardiogram was compatible with sinus rhythm and ventricular preexcitation pattern. After clinical stabilization, an electrophysiological study was performed confirming the presence of a left anterolateral accessory pathway with a short antegrade effective refractory period. Successful radiofrequency catheter ablation was achieved. Discussion. The reported clinical case recalls fundamental features of the Wolff-Parkinson-White syndrome and outlines the increasing evidence and importance of the invasive risk stratification and even catheter ablation in asymptomatic patients who suffer from this uncommon disease that may have a dramatic and fatal initial clinical manifestation.

scholarly journals SUDDEN CARDIAC DEATH AND WOLFF-PARKINSON-WHITE ELECTROCARDIOGRAPHIC PATTERN: A REVIEW

2014 ◽  
Vol 5 (4) ◽  
pp. 60-72
Author(s):  
S E Mamchur ◽  
A V Ardashev
Keyword(s):  
Catheter Ablation ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Radiofrequency Catheter Ablation ◽  
Electrophysiological Study ◽  
White Syndrome ◽  
Accessory Pathways ◽  
Asymptomatic Patients ◽  
Wolff Parkinson White Syndrome

The causes of sudden cardiac death in patients with Wolff-Parkinson-White syndrome are considered; necessity of endocardial electrophysiological study and radiofrequency catheter ablation is discussed, including asymptomatic patients with accessory pathways.

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 Asymptomatic Ventricular Pre-excitation: Between Sudden Cardiac Death and Catheter Ablation

2018 ◽  
Vol 7 (1) ◽  
pp. 32 ◽  
Author(s):  
Josep Brugada ◽  
Roberto Keegan ◽  
◽  
Keyword(s):  
Catheter Ablation ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Accessory Pathway ◽  
Structural Heart Disease ◽  
Clinical Situation ◽  
Clinical Approach ◽  
Asymptomatic Patients ◽  
Real Risk ◽  
Based Medicine

Debate about the best clinical approach to the management of asymptomatic patients with ventricular pre-excitation and advice on whether or not to invasively stratify and ablate is on-going. Weak evidence about the real risk of sudden cardiac death and the potential benefit of catheter ablation has probably prevented the clarification of action in this not infrequent and sometimes conflicting clinical situation. After analysing all available data, real evidence-based medicine could be the alternative strategy for managing this group of patients. According to recent surveys, most electrophysiologists invasively stratify. Based on all accepted risk factors – younger age, male, associated structural heart disease, posteroseptal localisation, ability of the accessory pathway to conduct anterogradely at short intervals of ≤250 milliseconds and inducibility of sustained atrioventricular re-entrant tachycardia and/or atrial fibrillation – a shared decisionmaking process on catheter ablation is proposed.

Accessory pathways-related tachycardias: Wolff–Parkinson–White syndrome and atrioventricular reentrant tachycardias

ESC CardioMed ◽  
2018 ◽  
pp. 2085-2091
Author(s):  
Jonathan Chrispin ◽  
Hugh Calkins
Keyword(s):  
High Risk ◽  
Catheter Ablation ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Epidemiological Studies ◽  
White Syndrome ◽  
Curative Therapy ◽  
Accessory Pathways ◽  
Accessory Atrioventricular Pathway ◽  
Wolff Parkinson White Syndrome

Wolff–Parkinson–White syndrome is an uncommon clinical condition defined as manifest pre-excitation on electrocardiogram and symptoms of arrhythmias related to the abnormal conduction between the atria and ventricle. Years of invasive electrophysiological, along with histological and epidemiological studies has grown our understanding of the accessory atrioventricular pathway responsible for Wolff–Parkinson–White syndrome. The overall prognosis for those with accessory pathways is excellent; however, a minority will experience symptomatic arrhythmias and rarely, sudden cardiac death. Fortunately, for those who are at high risk for sudden death, or for those who are highly symptomatic, catheter ablation has developed to become a curative therapy. This chapter details the anatomy, electrical properties, and assorted arrhythmias related to atrioventricular accessory pathways.

Slow and wide QRS complex tachycardia as a unique complication following radiofrequency catheter ablation of a left-sided accessory pathway in a child

2005 ◽  
Vol 15 (3) ◽  
pp. 315-318 ◽  
Author(s):  
Radu Vatasescu ◽  
Laszlo Kornyei ◽  
Tamas Szili-Torok
Keyword(s):  
Catheter Ablation ◽  
Slow Rate ◽  
Radiofrequency Catheter Ablation ◽  
Accessory Pathway ◽  
Qrs Complex ◽  
White Syndrome ◽  
Accessory Pathways ◽  
Radiofrequency Lesions ◽  
Transaortic Approach ◽  
Wolff Parkinson White Syndrome

Radiofrequency lesions can, theoretically, be the substrate for new persistent arrhythmias. As far as we know, this has never previously been encountered after transcatheter ablation of accessory pathways. A child with Wolff–Parkinson–White syndrome was referred for radiofrequency catheter ablation of a left-sided accessory pathway. After successful ablation of the accessory pathway using a retrograde transaortic approach, the child developed an incessant wide QRS complex tachycardia at slow rate that was resistant to pharmacologic interventions. The focus of the tachycardia was identical to the ventricular site of insertion of the eliminated accessory pathway.

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