Objective: Patients with Wolff-Parkinson-White (WPW) Syndrome require risk assessment to determine their potential for sudden cardiac death. Transesophageal electrophysiology studies (TEEPS) are an effective risk stra...Objective: Patients with Wolff-Parkinson-White (WPW) Syndrome require risk assessment to determine their potential for sudden cardiac death. Transesophageal electrophysiology studies (TEEPS) are an effective risk stratification tool. The purpose of this study is to describe a minimially invasive, effective anesthetic technique to employ during transesophageal electrophysiology studies. Methods: A retrospective review of anesthetic technique utilized during TEEPS. Inclusion criteria;WPW on ECG;age <18 years;and no history of tachycardia, palpitations, or syncope and patient had TEEPS under monitored anesthesia care (MAC). Midazolam, Fentanyl, and Propofol were used in various combinations. Sevoflurane was used during induction period in all GA cases and discontinued 10 minutes prior to initiation of TEEPS. Results: Inclusion criteria were met by 20 patients with an average age of 11.9 years, average weight of 48.9 kg and average height of 149.2 cm. IV sedation was performed on 15%, MAC on 10% and GA in remainder. Airway management techniques included 13.3% LMA, 20% endotrachael tube (ETT) and 66% mask. IV sedation, the initial anesthetic, was found to be cumbersome and uncomfortable. Next was ETT and LMA but trouble pacing was encountered due to positional change of the esophagus relative to the left atrium during ventilation. Mask induction was then performed in remaining 10 patients with TEEPS probe inserted through a nare while anesthesiologist continued mask ventilation. All mask procedures were successful without complications. Conclusions: Induction of anesthesia to perform TEEPS procedures on pediatric patients with Wolff-Parkinson-White syndrome underwent numerous attempts to make the procedure easy, reliable and reproducible for anesthesia and electrophysiologist. The eventual technique that proved to meet these criteria during a transesopheagel electrophysiology procedure was utilization of mask induction with continuous IV sedation.展开更多
Patients with a Wolff-Parkinson-White (WPW) pattern on their ECG can experience symptoms such as syncope, palpitations, supraventricular tachycardia, and atrial fibrillation, or they can be asymptomatic (aWPW). All pa...Patients with a Wolff-Parkinson-White (WPW) pattern on their ECG can experience symptoms such as syncope, palpitations, supraventricular tachycardia, and atrial fibrillation, or they can be asymptomatic (aWPW). All patients with WPW, regardless of the presence or absence of symptoms, are at risk of sudden death. Therefore, it is recommended that younger patients with WPW undergo studies to determine their risk. We report a previously asymptomatic WPW patient identified as high risk for sudden death due to?rapid conduction down her accessory pathway during atrial fibrillation induced during a trans-esophageal electrophysiology study.展开更多
WOLFF PARKINSON and WHITE (WPW) syndrome is the most common form of pre-excitation. It is associated in some cases with atrial fibrillation with a high risk of sudden death. We report the case of a 64-year-old hyperte...WOLFF PARKINSON and WHITE (WPW) syndrome is the most common form of pre-excitation. It is associated in some cases with atrial fibrillation with a high risk of sudden death. We report the case of a 64-year-old hypertensive woman with a history of ischemic stroke. She presented with hyperkinetic palpitations without hemodynamics instability on admission. The electrocardiogram recorded a complete tachyarrhythmia by pre-excitation atrial fibrillation, with a mean rate of 300 beats per minute. Electrophysiological investigation revealed an accessory pathway located at the ostium of the coronary sinus, which was successfully ablated by radiofrequency. A drug treatment based on flecaine 100 mg was introduced. The patient was asymptomatic after one month of outpatient follow-up.展开更多
We report a 35-year-old female patient with hypertrophic cardiomyopathy, left ventricular noncompaction, and Wolff-Parkinson-White EKG pattern. Several other family members present the same clinical condition. We spec...We report a 35-year-old female patient with hypertrophic cardiomyopathy, left ventricular noncompaction, and Wolff-Parkinson-White EKG pattern. Several other family members present the same clinical condition. We speculate that this phenotype is related to the genotypes PRKAG2 and LAMP2 represented by mutations of the genes encoding AMP-activated protein kinase (PRKAG2) and lysosome associated membrane protein 2 (LAMP2).展开更多
Objective To observe the effect of accessory pathway (AP) conduction on PJ interval in patients with Wolff-Parkinson-White syndrome. Methods 129 patients with a single manifestation of AP who underwent successful radi...Objective To observe the effect of accessory pathway (AP) conduction on PJ interval in patients with Wolff-Parkinson-White syndrome. Methods 129 patients with a single manifestation of AP who underwent successful radiofrequency ablation (RFCA) were included. Patients were divided into 10 groups according to AP location. The PR intervals, QRS durations and the PJ intervals were measured using simultaneous 12-lead ECG before and after ablation. The PJ intervals before ablation were compared with that after ablation. The atrioventricular (AV) conduction time via atrioventricular node-His conduction system before ablation were compared with the PR intervals after ablation. The ventricular depolarization time via atrioventricular node-His conduction system before ablation were compared with the QRS durations after ablation. Delta waves were compared between each two groups. Results (1) The PJ intervals of right posterior (RP) group and right posteroseptal (RPS) group before ablation were shorter than that after ablation (RP group 226±18 ms vs 236±19 ms, P<0.01, RPS group 221±18 ms vs 238±31 ms, P<0.05, respectively). (2) There were no significant differences between the atrioventricular (AV) conduction time via atrioventricular node-His conduction system before ablation and the PR intervals after ablation. (3)The ventricular depolarization time via atrioventricular node-His conduction system of RP group and RPS group before ablation were shorter than the PR intervals after ablation(RP group 79±12 ms vs 87±9 ms, P=0.01; RPS group 70±13 ms vs 86±9 ms, P<0.05, respectively). (4)The delta waves of RP group and RPS group were longer than that of left posterior group and left posteroseptal group(P<0.05). Conclusion PJ interval is shortened by AP conduction which pre-excites the general last excited part of left ventricle. It is determined by AP location and the extent of preexcitation.展开更多
We report electroversion in treatment of atrial fibrillation （AF） and atrioventricular nodal reentry ta- chycardia （AVNRT） in a patient with Wolff-Parkinson-White syndrome and cervical spinal cord injury. At first...We report electroversion in treatment of atrial fibrillation （AF） and atrioventricular nodal reentry ta- chycardia （AVNRT） in a patient with Wolff-Parkinson-White syndrome and cervical spinal cord injury. At first, the pa- tient sustained respiratory failure and weak cough reflex, thereafter repeated bronchoscopy was used to aspirate the sputum as well as control the pneumonia, which resulted in arrhythmia （AF and AVNRT）. Two doses of intravenousamiodarone failed to correct the arrhythmia. After restora- tion of sinus rhythm by electroversion, he was successfully weaned from mechanical ventilation and discharged from the intensive care unit without recurrent arrhythmia.展开更多
目的 探讨预激综合征(W P W)合并心房颤动(房颤)患者静脉注射胺碘酮的安全性。方法 选择接受射频消融治疗的W P W患者及同期行隐匿性房室旁路射频消融治疗的患者(对照组)各16例,测量W P W组患者预激旁路前传有效不应期(ERPAP)和对照...目的 探讨预激综合征(W P W)合并心房颤动(房颤)患者静脉注射胺碘酮的安全性。方法 选择接受射频消融治疗的W P W患者及同期行隐匿性房室旁路射频消融治疗的患者(对照组)各16例,测量W P W组患者预激旁路前传有效不应期(ERPAP)和对照组的房室结有效不应期(ERPAVN)。在10min内缓慢静脉注射胺碘酮150mg,10min后重复上述测量,并对结果进行对比分析。结果 W P W组用药后ERPAP有轻微延长(P<0 05),其中1例用药后缩短了60ms;对照组ERPAVN用药后明显延长(P<0 05)。结论 部分W P W合并房颤的患者静脉注射胺碘酮时,可能会促进激动经旁路下传,使心室率加快或引发心室颤动,需格外慎重。展开更多
文摘Objective: Patients with Wolff-Parkinson-White (WPW) Syndrome require risk assessment to determine their potential for sudden cardiac death. Transesophageal electrophysiology studies (TEEPS) are an effective risk stratification tool. The purpose of this study is to describe a minimially invasive, effective anesthetic technique to employ during transesophageal electrophysiology studies. Methods: A retrospective review of anesthetic technique utilized during TEEPS. Inclusion criteria;WPW on ECG;age <18 years;and no history of tachycardia, palpitations, or syncope and patient had TEEPS under monitored anesthesia care (MAC). Midazolam, Fentanyl, and Propofol were used in various combinations. Sevoflurane was used during induction period in all GA cases and discontinued 10 minutes prior to initiation of TEEPS. Results: Inclusion criteria were met by 20 patients with an average age of 11.9 years, average weight of 48.9 kg and average height of 149.2 cm. IV sedation was performed on 15%, MAC on 10% and GA in remainder. Airway management techniques included 13.3% LMA, 20% endotrachael tube (ETT) and 66% mask. IV sedation, the initial anesthetic, was found to be cumbersome and uncomfortable. Next was ETT and LMA but trouble pacing was encountered due to positional change of the esophagus relative to the left atrium during ventilation. Mask induction was then performed in remaining 10 patients with TEEPS probe inserted through a nare while anesthesiologist continued mask ventilation. All mask procedures were successful without complications. Conclusions: Induction of anesthesia to perform TEEPS procedures on pediatric patients with Wolff-Parkinson-White syndrome underwent numerous attempts to make the procedure easy, reliable and reproducible for anesthesia and electrophysiologist. The eventual technique that proved to meet these criteria during a transesopheagel electrophysiology procedure was utilization of mask induction with continuous IV sedation.
文摘Patients with a Wolff-Parkinson-White (WPW) pattern on their ECG can experience symptoms such as syncope, palpitations, supraventricular tachycardia, and atrial fibrillation, or they can be asymptomatic (aWPW). All patients with WPW, regardless of the presence or absence of symptoms, are at risk of sudden death. Therefore, it is recommended that younger patients with WPW undergo studies to determine their risk. We report a previously asymptomatic WPW patient identified as high risk for sudden death due to?rapid conduction down her accessory pathway during atrial fibrillation induced during a trans-esophageal electrophysiology study.
文摘WOLFF PARKINSON and WHITE (WPW) syndrome is the most common form of pre-excitation. It is associated in some cases with atrial fibrillation with a high risk of sudden death. We report the case of a 64-year-old hypertensive woman with a history of ischemic stroke. She presented with hyperkinetic palpitations without hemodynamics instability on admission. The electrocardiogram recorded a complete tachyarrhythmia by pre-excitation atrial fibrillation, with a mean rate of 300 beats per minute. Electrophysiological investigation revealed an accessory pathway located at the ostium of the coronary sinus, which was successfully ablated by radiofrequency. A drug treatment based on flecaine 100 mg was introduced. The patient was asymptomatic after one month of outpatient follow-up.
文摘We report a 35-year-old female patient with hypertrophic cardiomyopathy, left ventricular noncompaction, and Wolff-Parkinson-White EKG pattern. Several other family members present the same clinical condition. We speculate that this phenotype is related to the genotypes PRKAG2 and LAMP2 represented by mutations of the genes encoding AMP-activated protein kinase (PRKAG2) and lysosome associated membrane protein 2 (LAMP2).
文摘Objective To observe the effect of accessory pathway (AP) conduction on PJ interval in patients with Wolff-Parkinson-White syndrome. Methods 129 patients with a single manifestation of AP who underwent successful radiofrequency ablation (RFCA) were included. Patients were divided into 10 groups according to AP location. The PR intervals, QRS durations and the PJ intervals were measured using simultaneous 12-lead ECG before and after ablation. The PJ intervals before ablation were compared with that after ablation. The atrioventricular (AV) conduction time via atrioventricular node-His conduction system before ablation were compared with the PR intervals after ablation. The ventricular depolarization time via atrioventricular node-His conduction system before ablation were compared with the QRS durations after ablation. Delta waves were compared between each two groups. Results (1) The PJ intervals of right posterior (RP) group and right posteroseptal (RPS) group before ablation were shorter than that after ablation (RP group 226±18 ms vs 236±19 ms, P<0.01, RPS group 221±18 ms vs 238±31 ms, P<0.05, respectively). (2) There were no significant differences between the atrioventricular (AV) conduction time via atrioventricular node-His conduction system before ablation and the PR intervals after ablation. (3)The ventricular depolarization time via atrioventricular node-His conduction system of RP group and RPS group before ablation were shorter than the PR intervals after ablation(RP group 79±12 ms vs 87±9 ms, P=0.01; RPS group 70±13 ms vs 86±9 ms, P<0.05, respectively). (4)The delta waves of RP group and RPS group were longer than that of left posterior group and left posteroseptal group(P<0.05). Conclusion PJ interval is shortened by AP conduction which pre-excites the general last excited part of left ventricle. It is determined by AP location and the extent of preexcitation.
文摘We report electroversion in treatment of atrial fibrillation （AF） and atrioventricular nodal reentry ta- chycardia （AVNRT） in a patient with Wolff-Parkinson-White syndrome and cervical spinal cord injury. At first, the pa- tient sustained respiratory failure and weak cough reflex, thereafter repeated bronchoscopy was used to aspirate the sputum as well as control the pneumonia, which resulted in arrhythmia （AF and AVNRT）. Two doses of intravenousamiodarone failed to correct the arrhythmia. After restora- tion of sinus rhythm by electroversion, he was successfully weaned from mechanical ventilation and discharged from the intensive care unit without recurrent arrhythmia.
文摘目的 探讨预激综合征(W P W)合并心房颤动(房颤)患者静脉注射胺碘酮的安全性。方法 选择接受射频消融治疗的W P W患者及同期行隐匿性房室旁路射频消融治疗的患者(对照组)各16例,测量W P W组患者预激旁路前传有效不应期(ERPAP)和对照组的房室结有效不应期(ERPAVN)。在10min内缓慢静脉注射胺碘酮150mg,10min后重复上述测量,并对结果进行对比分析。结果 W P W组用药后ERPAP有轻微延长(P<0 05),其中1例用药后缩短了60ms;对照组ERPAVN用药后明显延长(P<0 05)。结论 部分W P W合并房颤的患者静脉注射胺碘酮时,可能会促进激动经旁路下传,使心室率加快或引发心室颤动,需格外慎重。
