Ebstein Anomaly Focusing on Pre-excited Atrial Fibrillation Management

Introduction: Ebstein’s anomaly is a rare abnormality of the heart associated with atrialization right ventricle and apical (downward) displacement of the tricuspid valve functional annulus. Twenty percents of patients with Ebstein’s anomaly accompanied with accessory pathway. The dilatation of atrium and aging process may develop atrial fibrillation (AF).Case Description: A 35 years old patient with recurrency palpitation, accompanied with dizziness and epigastric discomfort. He had history of taking propafenone 3 x 150 mg for long time while the palpitation recurrent. He was hospitalization due to propafenone could not suppress the palpitation. During monitor in hospital revealed haemodynamic stable with heart rate 160-180 beats/minute irregularly irregular. The electrocardiography showed atrial fibrillation with pre-excitation WPW syndrome. We performed electrical cardioversion 100 joule. Then the atrial fibrillation was convert to sinus rhythm with WPW pattern. The propafenone 3 x 150mg was continued. The patient was performed catheter radiofrequency ablation of the accessory pathway. Electrophysiology showed AV fusion at right anteroseptal pathway and preexcited atrial fibrillation with shortest RR interval 220 ms that converted by cardioversion. The ablation was successfully performed. Discussion: The accessory pathway is a complication of ebstein anomaly. Digoxin, beta-blockers, diltiazem, verapamil, and amiodarone are potentially harmful in pre-excited atrial fibrillation. Propafenone reduces fast inward potential by sodium channels, reduces spontaneous automaticity and prolongs the effective refractory periode so could be used in this case. Catheter ablation of accessory pathway in Ebstein anomaly with WPW syndrome was class I recommendation. In our case, the accessory pathway was successfully ablated.

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RADIOFREQUENCY ABLATION WPW SYNDROME IN PATIENT WITH EBSTEIN'S ANOMALY

Clinical Practice ◽

10.17816/clinpract1412-15 ◽

2010 ◽

Vol 1 (4) ◽

pp. 12-15 ◽

Cited By ~ 2

Author(s):

A V Ardashev ◽

E G Zhelyakov ◽

M S Rybachenko ◽

A V Konev

Keyword(s):

Radiofrequency Ablation ◽

Case History ◽

Cardiac Arrhythmias ◽

Surgical Correction ◽

Ebstein’S Anomaly ◽

Ebstein's Anomaly ◽

Wpw Syndrome ◽

History Of

The case history of 19-year old patient with Ebstein's anomaly and WPW syndrome, which was held surgical correction of cardiac arrhythmias by radiofrequency ablation is described. 3-year observation of patient confirmed the success of the operation – absence episodes of arrhythmia

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Management of Pregnancy in 31-Year-Old Woman with Persistent Atrial Flutter After Cone Reconstruction for Ebstein’s Anomaly

Cardiovascular and Cardiometabolic Journal (CCJ) ◽

10.20473/ccj.v1i1.2020.17-25 ◽

2020 ◽

Vol 1 (1) ◽

pp. 17

Author(s):

Eliana Susilowati

Keyword(s):

Heart Disease ◽

Atrial Flutter ◽

Tricuspid Regurgitation ◽

Signs And Symptoms ◽

Right Ventricular Failure ◽

Ebstein’S Anomaly ◽

Ventricular Failure ◽

Ebstein Anomaly ◽

Ebstein's Anomaly ◽

History Of

There is a growing number of mothers suffering innate heart disease which could potentially risk their gestation period. Ebstein’s anomaly refers to a rare innate disease in the heart which accounts for less than 1% of most cases of innate heart disease, and only 5% of the patients surviving beyond 50 years of age. Cone reconstruction (CR) is an option for the repairment of tricuspid valve in patients with Ebstein anomaly. However, persistent arrhytmia, such as AFL, is possible to occur after CR. This case report aims to opt suitable pregnancy management of patients with persistent atrial flutter (AFL) after Cone reconstruction for Ebstein’s Anomaly. We report a 31 year-old woman who consulted for pregnancy planning due to history of Ebstein’s Anomaly, and had undergone successful cone reconstruction. No recorded history of AFL is reported. Physical examination finding was tricuspid regurgitation murmur without signs and symptoms of right ventricular failure. Electrocardiography showed counter-clockwise typical AFL. Echocardiography finding demonstrated post Cone reconstruction (CR), mild tricuspid regurgitation, and EF of 76%.

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Ebstein's anomaly as a cause of paroxysmal atrial fibrillation

Vojnosanitetski pregled ◽

10.2298/vsp0811847d ◽

2008 ◽

Vol 65 (11) ◽

pp. 847-850

Author(s):

Miodrag Damjanovic ◽

Danijela Djordjevic-Radojkovic ◽

Zoran Perisic ◽

Svetlana Apostolovic ◽

Goran Koracevic ◽

...

Keyword(s):

Atrial Fibrillation ◽

Right Ventricle ◽

Tricuspid Valve ◽

Paroxysmal Atrial Fibrillation ◽

Ebstein’S Anomaly ◽

Ebstein's Anomaly ◽

Wpw Syndrome ◽

Echocardiographic Examination ◽

Electrophysiological Examination ◽

The Right

Background. Ebstein's anomaly is characterized by a displacement of the tricuspid valve toward apex, because of anomalous attachment of the tricuspid leaflets. There are type B of Wolff-Parkinson-White (WPW) syndrome and paroxysmal arrhythmias in more than a half of all patients. Case report. We presented a female, 32-year old, with frequent paroxysms of atrial fibrillation. After conversion of rhythm an ECG showed WPW syndrome. Echocardiographic examination discovered normal size of the left cardiac chambers with paradoxical ventricular septal motion. The right ventricle was very small because of its atrialization. The origin of the tricuspid valve was 20 mm closer to apex of the right ventricle than the origin of the mitral valve. Electrophysiological examination showed a posterolateral right accesorial pathway. Atrial fibrillation was induced very easily in electrophysiological laboratory and a successful ablation of accessorial pathway was made. There were no WPW syndrome and paroxysms of atrial fibrillation after that. Conclusion. Ebstein's anomaly is one of the reasons of paroxysmal atrial fibrillation, especially in young persons with WPW syndrome.

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Diagnosis and natural history of Ebstein's anomaly.

Heart ◽

10.1136/hrt.54.5.517 ◽

1985 ◽

Vol 54 (5) ◽

pp. 517-522 ◽

Cited By ~ 49

Author(s):

D J Radford ◽

R F Graff ◽

G H Neilson

Keyword(s):

Natural History ◽

Ebstein’S Anomaly ◽

Ebstein's Anomaly ◽

History Of

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Catheter ablation for atrial fibrillation in very young patients

EP Europace ◽

10.1093/europace/euab116.202 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

K Yalin ◽

B Ikitimur ◽

T Aksu ◽

AU Soysal ◽

E Lyan ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Pulmonary Vein ◽

Accessory Pathway ◽

Young Patients ◽

Old Patients ◽

Index Procedure ◽

Holter Ecg ◽

History Of

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Pulmonary vein automaticity is an established trigger of paroxysmal atrial fibrillation (PAF) making pulmonary vein isolation (PVI) the cornerstone for catheter ablation. However, data on triggers of AF and catheter ablation strategy in very young (<30 years old) patients are sparse. Methods and results: Sixteen young patients (mean age 25.2 ± 4.9 years; 75% men) with recurrent drug refractory PAF underwent EP study and ablation at 3 EP centers. None of the patients had structural heart disease or family history of AF. EP study revealed degeneration of induced supraventricular tachycardia (SVT) into AF in 5 patients (n = 5, 31.2%). Induced SVTs were left lateral concealed accessory pathway mediated orthodromic AVRT in two patients, typical AVNRT in two patients, and left superior PV tachycardia in one patient respectively. In patients with induced SVTs, SVT ablation without PVI was performed as an index procedure. Remaining patients underwent second generation cryoballoon (CB-2) based PVI (n = 11, 68.7%). There were no major complications related to ablation procedures. Follow-up was based on outpatient visits including 24-h Holter-ECG at 3, 6 and, 12 months post ablation, or additional Holter-ECG was ordered in case of symptoms suggesting recurrence. Recurrence was defined as any atrial tachyarrhythmia (ATA) episode >30s following a 3-month blanking period. After a median follow-up of 18.3 ± 6.2 months, 13 of 16 (81.2%) patients were free of ATA recurrence. None of the patients belonging to SVT ablation only group experienced ATA recurrence. Three patients with previous CB-2 PVI recurred, one had typical atrial flutter and underwent CTI ablation, remaining 2 patients had AF recurrence and medically followed. Conclusion In a considerable fraction of young adult patients with history of PAF SVTs may be responsible and SVT ablation without PVI may be sufficient as an index procedure. Catheter ablation AF seems to be safe and effective in this population.

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Ebsteins Anomaly Corrected by Tissue Valve: Case Report

Cardiovascular Journal ◽

10.3329/cardio.v1i1.8213 ◽

1970 ◽

Vol 1 (1) ◽

pp. 112-114

Author(s):

SAMA Sabur ◽

Z Rashid ◽

A Fazel ◽

MMG Chowdhury ◽

M Zaman ◽

...

Keyword(s):

Tricuspid Valve ◽

Congenital Heart ◽

Heart Diseases ◽

Ebstein’S Anomaly ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Ebstein's Anomaly ◽

Wpw Syndrome ◽

Tissue Valve ◽

Bidirectional Glenn Shunt

Ebstein’s anomaly is a rare form of congenital heart disease with incidence of 1% of all congenital heart diseases. There are two modes of surgical correction of Ebstein’s anomaly: either biventricular repair with or without tricuspid valve replacement, or palliative univentricular repair consisting of bidirectional Glenn shunt or Fontan procedure. We treated a case of severe form of Ebstein’s anomaly with ASD secundum with WPW syndrome. Radiofrequency ablation was done to treat WPW syndrome preoperatively. Celermajer’s index is a prognostic indicator for tricuspid valve repair or replacement. On 04.03.08 tricuspid valve was replaced with 31 mm Carpentier-Edwards bovine pericardial valve under cardiopulmonary bypass. Postoperative period was uneventful. Follow up echo done on 01.06.08 which revealed normally functioning tissue valve found in tricuspid position TR Grade I. So, in conclusion, preoperative evaluation and workout of Celermajer’s index is essential before surgical intervention for decision of tricuspid valve repair or replacement. Last but not the least, any event of arrhythmia should be properly evaluated.Key words: Ebstein’s anomaly, WPW (Wolff- Parkinson-White) Syndrome, Celermajer’s index, Tissue valve. DOI: http://dx.doi.org/10.3329/cardio.v1i1.8213 Cardiovasc. j. 2008; 1(1) : 112-114

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