Differential effective refractory period as a useful marker of multiple accessory pathways

Helm, Robert H.; Varkey, Santosh; Karnik, Ankur A.

doi:10.1002/joa3.12162

Cited by 2 publications

(3 citation statements)

References 6 publications

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“…The 33 patients who met inclusion criteria for an antegrade-only accessory pathway are the subjects of this analysis. The median patient age at time of the electrophysiology study was 14 [10][11][12][13][14][15][16] years and 16 (48%) were male (Table 1). The most common presenting symptoms were palpitations (47%), chest pain (25%), and syncope (22%).…”

Section: Resultsmentioning

confidence: 99%

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Characteristics of antegrade-only accessory pathways in children and adolescents

et al. 2021

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There is minimal data regarding antegrade-only accessory pathways in young patients. Given evolving recommendations and treatments, retrospective analysis of the clinical and electrophysiologic properties of antegrade-only pathways in patients <21 years old was performed, with subsequent comparison of electrophysiology properties to age-matched controls with bidirectional pathways. Of 522 consecutive young patients with ventricular pre-excitation referred for electrophysiology study, 33 (6.3%) had antegrade-only accessory pathways. Indications included palpitations (47%), chest pain (25%), and syncope (22%). The shortest value for either the accessory pathway effective refractory period or the pre-excited R-R interval was taken for each patient, with the median of the antegrade-only group significantly greater than shortest values for the bidirectional group (310 [280–360] ms versus 270 [240–302] ms, p < 0.001). However, the prevalence of pathways with high-risk properties (effective refractory period or shortest pre-excited R-R interval <250 ms) was similar in both study patients and controls (13% versus 21%) (p = 0.55). Sixteen patients had a single antegrade-only accessory pathway and no inducible arrhythmia. Six patients had Mahaim fibres, all right anterolateral with inducible antidromic reciprocating tachycardia. However, 11 patients with antegrade-only accessory pathways and 3 with Mahaim fibres had inducible tachycardia due to a second substrate recognised at electrophysiology study. These included concealed accessory pathways (7), bidirectional accessory pathways (5), and atrioventricular node re-entry (2). Antegrade-only accessory pathways require comprehensive electrophysiology evaluation as confounding factors such as high-risk conduction properties or inducible Supraventricular Tachycardia (SVT) due to a second substrate of tachycardia are often present.

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Section: Resultsmentioning

confidence: 99%

“…The findings of a differential effective refractory period with programmed stimulation with a change in the pattern of pre-excitation was observed in three of the four cases with multiple antegrade accessory pathways and has been reported to be a useful finding to suggest the presence of multiple accessory pathways. 14…”

Section: Discussionmentioning

confidence: 99%

Characteristics of antegrade-only accessory pathways in children and adolescents

et al. 2021

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“…Afflicted individuals might harbor a heightened predisposition to conditions like supraventricular tachycardia (SVT), antidromic reentrant circuits, expedited conduction during atrial fibrillation (AF), and ventricular fibrillation. 13 It's well-acknowledged within the medical community that ventricular fibrillation (VF) can manifest due to sustained preexcited atrial fibrillation (AF), even in the absence of underlying structural heart abnormalities. This occurrence becomes especially pertinent when multiple accessory pathways (APs) coexist.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Orthodromic SVT AVRT with Multiple Accessory Pathway in WPW Syndrome: Ablate All or Not?

Aziz,

Rizal

2024

HSJ

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Background: Patients diagnosed with Wolff-Parkinson-White syndrome (WPW) have a relatively low, nevertheless persistent risk of unexpected mortality. However, this risk can be effectively mitigated by applying radiofrequency catheter ablation targeting the accessory pathway. It is difficult to accurately study predictors because only a minority of patients develop potentially malignant arrhythmias (MA) or passed away, despite essential risk variables being relatively well-known.1 This study aimed to describe ablation in WPW syndrome. Case presentation: A 16-year-old male presents with symptoms characterized by palpitations during intense physical exertion, followed by chest pain episodes. The physical examination, CXR, laboratorium, and echocardiography were all within the normal range; his ECG showed shortened PR interval and a delta wave with a positive delta wave at V1 and mostly positive at the inferior lead. He also has recorded ECG when the patient has a tachycardia event with SVT AVRT orthodromic pattern. He underwent EP Study and had several accessory pathways at the posteroseptal mitral annulus and anteroseptal tricuspid. The decision was made to perform ablation on the posteroseptal accessory pathway located at the mitral annulus. An electrophysiology (EP) investigation was conducted at the anteroseptal tricuspid annulus, which did not induce tachyarrhythmia. Conclusion: Wolff-Parkinson-White syndrome is a congenital cardiac pathway formation, with not all accessory pathways causing tachyarrhythmias. Ablation therapy is necessary for patients with multiple pathways, with pathways with an ERP less than 250 being the only option. Keyword: Ablation, Multiple Accessories Pathway, SVT AVRT Orthodromic, WPW Syndrome.

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Differential effective refractory period as a useful marker of multiple accessory pathways

Cited by 2 publications

References 6 publications

Characteristics of antegrade-only accessory pathways in children and adolescents

Characteristics of antegrade-only accessory pathways in children and adolescents

Recurrent Orthodromic SVT AVRT with Multiple Accessory Pathway in WPW Syndrome: Ablate All or Not?

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