Anatomic Findings in a Case of Ventricular Pre-Excitation (WPW) Terminating in Complete Atrioventricular Block

Lev, Maurice; Leffler, William B.; Langendorf, Richard; Pick, Alfred

doi:10.1161/01.cir.34.5.718

Cited by 103 publications

(22 citation statements)

References 27 publications

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“…Lev et al documented this combination in a patient with pre-excitation syndrome who subsequently developed complete A-V block [32]. The role of the Mahaim fibres was also considered in patients with accessory pathways and decremental conduction properties.…”

Section: Anatomical Substrate Of Pre-excitation Syndromementioning

confidence: 99%

How to approach left-sided accessory pathway ablation using intracardiac echocardiography

Szili-Török¹

2001

Europace

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This brief review discusses the interesting early history of the preexcitation syndrome. In 1913 Cohn and Fraser published the first patient with a short P-R interval, wide QRS complexes, and paroxysmal tachycardia. This was followed by other cases of pre-excitation syndrome, all of which were considered to be due to bundle branch blocks. In 1930 Wolff, Parkinson, and White reported 11 patients with the syndrome, which came to bear their name. Two years later, Holzmann and Scherf suggested bypass tracts as the most likely mechanism of preexcitation syndrome. In 1942, Wood et al. documented the first accessory connection at autopsy. Despite these early studies supporting the bypass theory, the quest for alternative mechanisms continued until the 1970s when electrophysiological studies and surgical therapy confirmed accessory connections as the mechanism of pre-excitation syndrome.

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Section: Anatomical Substrate Of Pre-excitation Syndromementioning

confidence: 99%

How to approach left-sided accessory pathway ablation using intracardiac echocardiography

Szili-Török¹

2001

Europace

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“…5 " 8 The atrioventricular block may be masked by anterograde conduction over the accessory pathway and becomes apparent only when the "extranodal" conduction is lost. 9 Our study describes 5 children in whom pre-excitation complicated the evaluation of their atrioventricular conduction. The coexistence of these phenomena had a major impact on their clinical course and management.…”

Section: Discussionmentioning

confidence: 99%

Coexistence of atrioventricular block and Wolff-Parkinson-White syndrome in children

1997

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Coexistence of atrioventricular block and Wolff-Parkinson-White syndrome is uncommon, but may occur in children, particularly with certain congenital heart defects. Our study describes 5 children who had pre-excitation and underlying disturbance of atrioventricular conduction. All of these patients had structural heart defects, consisting of discordant atrioventricular connections in three, double inlet left ventricle in one, and a ventricular septal defect associated with straddling of the tricuspid valve in the other. In 4 of the patients, the presence of atrioventricular block was initially masked by the pre-excitation. When the conduction through an accessory pathway is lost, the child may be left with atrioventricular block, which is poorly tolerated in the setting of complex cardiac anatomy. Awareness of this association of Wolff-Parkinson-White syndrome and atrioventricular block is important in understanding the natural history and the management of children with congenital heart defects that are associated with tenuous atrioventricular conduction.

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“…Anatomic confirmation that the association of two accessory pathways in series, a James tract and Mahaim fiber can occur has been presented by Lev ei al. [ 12].…”

Section: Discussionmentioning

confidence: 99%

His Bundle Electrocardiography in the Wolff-Parkinson-Syndrome

Gomes¹,

Haft²

1977

Cardiology

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His bundle electrographic studies with atrial pacing in 2 of 8 patients with the Wolff-Parkinson-White (WPW) syndrome demonstrated evidence for the combination of a James tract and Mahaim fibers. During normal sinus rhythm these 2 patients had P-H intervals of 65 and 75 msec and H-Q intervals of 15 and 35 msec, respectively. On atrial pacing, the P-H intervals showed a small increase with the H-Q intervals remaining constant. The QRS duration, δ-wave duration and P-J intervals remained relatively constant. These observations strikingly contrasted with the findings typical of Kent-type conduction in the remaining 6 patients in whom during sinus rhythm, the His depolarization occurred simultaneously with the onset of the (δ -wave on the surface ECG. During atrial pacing (ranges 85–174/min), in these 6 patients, there was a progressive increase in the duration of the δ -wave, gradual increase in the P-H and Q-H intervals, and an increase in the QRS duration. 5 of these 6 patients showed a progressive increase in the P-J intervals. These observations suggest a practical method for determining in the individual patient whether anomalous conduction is occurring via a Kent-type pathway or a combination of a James tract and Mahaim fibers arranged in series.

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Anatomic Findings in a Case of Ventricular Pre-Excitation (WPW) Terminating in Complete Atrioventricular Block

Cited by 103 publications

References 27 publications

How to approach left-sided accessory pathway ablation using intracardiac echocardiography

How to approach left-sided accessory pathway ablation using intracardiac echocardiography

Coexistence of atrioventricular block and Wolff-Parkinson-White syndrome in children

His Bundle Electrocardiography in the Wolff-Parkinson-Syndrome

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