Historical aspects of the development of the theory of ventricular preexcitation

The paper conducts a review of the literature on the problem of cognition of the nature of the syndrome of preexcitation of the ventricles. Despite the data of early publications, supporting the theory of bypass as a substrate of preexcitation, disputes and searches for the nature of this clinical syndrome continued until 1970, until surgical procedures and the first electrophysiological studies confirmed the “bypass” of the normal conducting system. Article describes the chronology of events related to the understanding of the syndrome, which bears the name Wolff-Parkinson-White.

EKG Findings Mimicking Pericarditis and STEMI in a patient with Ventricular Preexcitation: A Case Report

Wolff-Parkinson-White (WPW) syndrome is an electrical conduction abnormality of the heart in which atrial impulses are transmitted to the ventricle through an accessory pathway, leading to supraventricular tachycardia [1]. On EKG, WPW presents with shortened PR interval, widened QRS, and a characteristic delta wave. Here, we present the case of 44-year-old African American male with a history of preexcitation/WPW pattern and no known history of coronary artery disease who came to the hospital complaining of atypical chest pain. He had transient ST elevation in beats with delta waves, both in the ambulance and emergency room EKGs (Figure 1 and 2) . Five minutes later, a repeat EKG showed ST elevation along with PR depression mimicking pericarditis (Figure 4) . Cardiac enzymes remained normal. EKG stress test with myocardial perfusion imaging was negative for ischemia and echocardiogram was normal.

A Brief review of the risks and the stratification of sudden death in the ventricular Pre-excitation syndrome.

Objective: The diagnosis of ventricular preexcitation syndromes is often occasional and with underestimated risk, showing controversies in its stratification and indication of prophylactic ablation. This work aims to explore and summarize the data in the literature, exposing the authors’ conclusions regarding this review. Methods: The authors prepared this work based on the latest guideline of the European Society of Cardiology plus a search for articles published in MEDLINE whose titles related to sudden death from ventricular fibrillation in patients with ventricular preexcitation. Discussion: Sudden death secondary to preexcited atrial fibrillation with degeneration to ventricular fibrillation is the most feared event in Wolff-Parkinson-White syndrome, has an average annual incidence of 0.15 to 0.39%, affecting individuals with structurally normal heart. The noninvasive stratification methods do not demonstrate adequate efficacy, and an electrophysiological study is recommended for all cases at the time of diagnosis. The most severe criteria for sudden death are shortest preexcited RR interval ≤ 250 ms (SPERRI or SPRRI); accessory pathway effective refractory period (APERP) ≤ 250 ms; presence of multiple accessory bundles; shortest paced cycle length with preexcitation during atrial pacing ≤ 250ms (SPPCL); Ebstein anomaly; induction of sustained supraventricular tachycardia. Conclusion: The low rate of complications during the diagnostic exam as well as in the therapeutic procedure, added to the high percentage of success of radiofrequency ablation, leads to indicate early the execution of electrophysiological study as a more diligent and accurate measure in the reduction of sudden death events in patients with ventricular preexcitation syndromes.