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The current approach for catheter ablation (CA) of accessory pathways (AP) includes the use of standard catheters under fluoroscopic visualization. We hypothesize that use of contact force (CF) irrigated tip catheters might increase procedural safety in pediatric patients compared to standard irrigated tip catheters, by decreasing the number of radiofrequency (RF) pulses required to obtain AP elimination. Seventy-one pediatric patients (13.7 ± 2.5 years, 45 male) with ventricular pre-excitation were enrolled in the study. CA was performed with a standard irrigated tip catheter up to June 2013 in 41 patients (Group S) and with a CF sensing irrigated tip catheter later on in 30 patients (Group CF). In the Group CF, RF was applied with a minimal CF of 5 g; CF > 35 g was avoided. Group CF procedures required less fluoroscopy (6.8 ± 4.8 min), compared to Group S (12.2 ± 10.8 min, p = 0.007). The number of RF pulses was smaller in Group CF compared to Group S (2.5 ± 2.0 vs 5.5 ± 1.9, p < 0.01). The mean CF during the effective RF pulse was 18 ± 7.7 g, force–time integral was 1040.7 ± 955.9 gs, Ablation Index was 513.0 ± 214.2. The procedure was acutely successful in 70 patients; at 12 months follow-up 2 patients had AP recurrence, one for each group. No major complications were reported. The use of CF irrigated tip catheters was associated with a smaller number of RF pulses and less fluoroscopy, as compared to mapping and ablation with standard irrigated tip catheters. [ABSTRACT FROM AUTHOR]

The atrioventricular node (AV) is considered the electrical connection between the atria and ventricles. There is an electrical pause between activation of the atria and the ventricles (PR segment), but to date the mechanism responsible for this interruption remains unclear. The present communication focuses on the hypothesis that magnetic field dynamics could provide the answer. Proof of this hypothesis is that in Wolff-Parkinson-White syndrome, where there is physical connection between the atria and ventricles (bundle of Kent), there is electrical AV continuity, no PR segment is detected, and catheter ablation of the abnormal bundle restores AV discontinuity. Spontaneous initiation of the heart at the level of the sinus node, the pacemaker of the heart, could also be explained via field dynamics. The known transmembrane pacemaker protein CHN4, present in both sinoatrial and AV nodal cells, could interact with field information to provide specificity in an electronic key-to-lock mechanism interaction. [ABSTRACT FROM AUTHOR]

Wolff–Parkinson–White (WPW) syndrome is a rare abnormal condition frequently associated with paroxysmal supraventricular tachycardia (PSVT) and is described as an arrhythmia under the form of increased heartbeat. Currently, there are various possible treatments going from medicines such as adenosine and beta-blockers to cardioversion. The unknown causes of this condition together with the different responses to treatment in each patient make it difficult to establish the best therapeutic approach. In this context, in the current paper, we were interested in reporting the therapeutic options and their efficiency in the case of associated heart or inflammatory conditions in a 13-day-old patient.

A 16-year-old female presented to the emergency department with complaints of palpitations of two hours duration. She had similar episodes in the past brought on by stress, anger, chocolate, or coffee. The ECG obtained in the course of her medical work-up led to the diagnosis of Wolff-Parkinson-White (WPW) syndrome. The characteristic short PR segment and delta wave are best seen in the lead I rhythm strip. In this rare example, the electrocardiographic morphology alternates between multiple beats of WPW and beats of normal sinus rhythm (A). It is important to recognize the characteristic features of pre-excitation syndromes such as WPW as patients may require treatment with antiarrhythmic drugs and/or radiofrequency ablation. Furthermore, emergency management of tachyarrhythmias in patients with a known history of WPW may differ from those without. However, as demonstrated in this example, such findings may be intermittent thus making an accurate and timely diagnosis challenging. Once it is apparent, proper documentation with copies of the ECG or rhythm strip in the patient record is imperative. In this case, the patient was also provided with a copy of her ECG to show the cardiologist which proved to be important since a repeat ECG at the cardiology clinic later the same day was unremarkable (B).

Catheter ablation is the treatment of choice for patients with symptomatic accessory pathways (APs) causing recurrent atrioventricular reciprocating tachycardia or in situations where APs conduct rapidly, posing a risk of sudden cardiac death. Conventional AP mapping relies on point-by-point assessment of local electrograms looking closely for pathway electrograms or early atrial or ventricular electrograms, which may be challenging and time consuming. Recently, open window mapping (OWM) using 3D navigational systems has emerged as a novel technique to help localise and ablate APs. OWM has significant advantages over conventional point-by-point mapping techniques. The purpose of this review is to summarise the currently available literature on the OWM technique and to highlight the technical aspects and mapping considerations for OWM, including specific cases demonstrating its utility., Competing Interests: Disclosure: AC is an employee of Abbott. JG is an employee of Biosense Webster. NTS is on the Arrhythmia & Electrophysiology Review editorial board; this did not influence peer review. All other authors have no conflicts of interest to declare., (Copyright © The Author(s), 2023. Published by Radcliffe Group Ltd.)

Abstract Background Transcatheter ablation is the most effective treatment for patients with symptomatic or high-risk accessory pathways (AP). At present, no clear recommendations have been issued on the optimal approach for left sided AP ablation. We performed this meta-analysis to compare the safety and efficacy of transaortic retrograde versus transseptal approach for left sided AP ablation. Methods and results MEDLINE/PubMed and Cochrane database were searched for pertinent articles from 1990 until 2016. Following inclusion/exclusion criteria application, 29 studies were selected including 2030 patients (1013 retrograde, 1017 transseptal) from 28 observational single Centre studies and one randomized trial. Patients approached by transseptal puncture presented a significantly higher acute success (98% vs. 94%, p = 0.040). The incidence of late recurrences (p = 0.381) and complications (p = 0.301) did not differ among the two groups, but the pattern of complications differed: vascular complications were more frequent with transaortic retrograde approach, while cardiac tamponade was the main transseptal complication. No difference was noted in terms of procedural duration and fluoroscopy time (p = 0.230 and p = 0.980, respectively). Meta-regression analysis showed no relation between year of publication and acute success (p = 0.325) or incidence of complications (p = 0.795); additionally, no direct relation was found between age and acute success (p = 0.256) or complications (p = 0.863). Conclusions Left sided AP transcatheter ablation is effective in around 95% of the cases, with a very limited incidence of complications. Transseptal access provides higher acute success in achieving AP ablation; late recurrences are rare but observed similarly following both approaches. Retrograde approach is affected by a relatively high incidence of vascular complications. Highlights • Left side AP transcatheter ablation is effective in around 95% of the patients. • Transseptal access provides a higher acute success in achieving AP ablation. • Retrograde approach is affected by a relatively higher incidence of vascular complications. • Recurrences are limited and do not differ between the two approaches. [ABSTRACT FROM AUTHOR]

Purpose: Our aim was to investigate the relation between delta wave notching time (DwNt) and accessory pathway location in patients with Wolff-Parkinson-White (WPW) syndrome.Methods: The retrospective study included 149 WPW patients who underwent ablation therapy. DwNt was defined as the duration between the initial point of QRS and the notching in the delta wave. DwNt was divided by QRS duration to obtain the delta wave index (Dwi).Results: Patients with left-sided accessory pathway (AP) had significantly higher DwNt (p < 0.001) and Dwi (p = 0.027) values. The R wave voltage in lead I (p = 0.037) and S wave voltage in lead V1 (p = 0.005) values were significantly higher in patients with right-sided AP compared to patients with left-sided AP. When 27 ms was taken as the DwNt cut-off value, higher durations determined the left-sided AP location with a sensitivity of 91% and a negative predictive value of 91.4%. Dwi cutoff values ≥ 0.29 were accepted to indicate a left-sided AP location with a sensitivity of 91.2% and a NPV of 91.4%.Conclusions: WPW patients with left-sided AP have longer DwNt values than patients with right-sided AP. [ABSTRACT FROM AUTHOR]

History of present illness: A 38-year-old male presents to the emergency department for a minor trauma evaluation after falling off a bicycle at a moderate rate of speed. The patient was not wearing a helmet when he hit his head with unknown loss of consciousness. Focused assessment with sonography for trauma (FAST) exam and head computed tomography (CT) were negative. Routine electrocardiogram (ECG) showed sinus rhythm with pre-excitation indicative of Wolff-Parkinson-White Syndrome (WPW). The patient confirmed a previous diagnosis of WPW, but had not previously followed up with a cardiologist. Significant findings: The ECG shows slurred up-stroking of the QRS complexes characteristic of a delta wave. The PR interval is normal; however, the QT interval is greater than 110ms. Discussion: Wolff-Parkinson-White Syndrome (WPW) is a frequently encountered macro-reentrant arrhythmia characterized by a shortened PR interval less than 120ms, prolonged QRS greater than 120ms with an up-stroking QRS complex (delta wave), and occasional ST abnormalities.1 The incidence is reported to be 0.9%-3% of the general population and most diagnoses are made on routine EKGs.2,3 WPW is thought to be caused by abnormalities of conduction through the accessory pathway, also known as the Bundle of Kent, causing premature excitation of the ventricles. The complications from WPW are supraventricular tachycardia, atrial arrhythmias, and ventricular fibrillation leading to sudden cardiac death.3 Approximately 40-50% of patients who die from sudden cardiac arrest associated with WPW were previously asymptomatic.4 Unfortunately, it is agreed that approximately 50% of patients with WPW are asymptomatic and unaware of their diagnosis.5 The definitive treatment for WPW is radiofrequency catheter ablation (RFCA). However, it comes with a low risk of complications including arrhythmias and death.6 For asymptomatic WPW, children are at the highest risk for ventricular arrhythmias while those over the age of 35 to 40 have a lower risk.7 For asymptomatic patients where the diagnosis is uncertain, electrophysiological studies (EPS) may be utilized to determine the patient’s risk for future arrhythmias and for the need for RFCA.1 RFCA may not be appropriate for every patient and is not an urgent procedure for stable, asymptomatic WPW. Our patient was discharged after evaluation for traumatic injuries was negative and we recommended that he follow-up with his primary care provider for continued management of his WPW.

Aims: Mutations in PRKAG2, the gene encoding for the γ2 subunit of 5'-AMP-activated protein kinase (AMPK), are responsible for an autosomal dominant glycogenosis with a cardiac presentation, associating hypertrophic cardiomyopathy (HCM), ventricular pre-excitation (VPE), and progressive heart block. The aim of this study was to perform a retrospective time-to-event study of the clinical manifestations associated with PRKAG2 mutations.Methods and Results: A cohort of 34 patients from 9 families was recruited between 2001 and 2010. DNA were sequenced on all exons and flanking sequences of the PRKAG2 gene using Sanger sequencing. Overall, four families carried the recurrent p.Arg302Gln mutation, and the five others carried private mutations among which three had never been reported. In the total cohort, at 40 years of age, the risk of developing HCM was 61%, VPE 70%, conduction block 22%, and sudden cardiac death (SCD) 20%. The global survival at 60 years of age was 66%. Thirty-two per cent of patients (N = 10) required a device implantation (5 pacemakers and 5 defibrillators) at a median age of 66 years, and two patients required heart transplant. Only one patient presented with significant skeletal muscle symptoms. No significant differences regarding the occurrence of VPE, ablation complications, or death incidence were observed between different mutations.Conclusion: This study of patients with PRKAG2 mutations provides a more comprehensive view of the natural history of this disease and demonstrates a high risk of cardiac complications. Early recognition of this disease appears important to allow an appropriate management. [ABSTRACT FROM AUTHOR]

Background: One of the principal tasks of an emergency physician is identifying potentially life-threatening conditions in the undifferentiated patient; cardiac dysrhythmia is an example of such a condition. A systematic approach to a patient with atypical dysrhythmia enables proper identification of such-life threatening conditions.Case Report: We describe a 31-year-old man presenting to the emergency department with an undifferentiated dysrhythmia after naloxone reversal of an opiate overdose. A systematic approach to the electrocardiogram led to the rare diagnosis of Wolff-Parkinson-White (WPW) alternans. We review the differential diagnosis of this dysrhythmia and the initial evaluation of a patient with the WPW pattern present on their electrocardiogram. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be prepared to use a systematic approach to an undifferentiated dysrhythmia to identify potentially life-threatening conditions. [ABSTRACT FROM AUTHOR]

Twelve-lead ECG of a child with Wolff-Parkinson-White syndrome and systolic dysfunction was consistent with the anteroseptal accessory pathway. The earliest atrial activation during electrophysiological study was found between the right anteroseptal region near the HIS. Multiple femoral tract right-sided cryotest lesions followed by radiofrequency catheter irrigated through the jugular vein route were unsuccessful. Then, non-coronary aortic cusp mapping and cryoablation were successfully performed with a retroartic approach.

Aims: Wolff-Parkinson-White (WPW) syndrome is a conduction disorder characterized by an accessory electrical pathway between the atria and ventricles, which may predispose to supraventricular tachycardia (SVT) and sudden cardiac death. It can be seen as an isolated finding or associated with structural heart disease. Our aims were to determine the prevalence of a WPW pattern in a large and unselected cohort of neonates and to describe the electro- and echocardiographic characteristics as well as the natural history during early childhood., Methods and Results: Electrocardiograms and echocardiograms of neonates (aged 0-30 days) from a large, prospective, population-based cohort study were included. Neonates with a WPW pattern were identified and matched 1:4 to controls. Localization of the accessory pathway was assessed by different algorithms. Among 17 489 neonates, we identified 17 (76% boys) with a WPW pattern consistent with a prevalence of 0.1%. One neonate had moderate mitral regurgitation while other echocardiographic parameters were similar between cases and controls (all P > 0.05). The accessory pathways were primarily predicted to be left-sided. At follow-up (available in 14/17 children; mean age 3.2 years) the pre-excitation pattern persisted in only four of the children and none of the children had experienced any episodes of SVT., Conclusion: The prevalence of a WPW pattern in our cohort of unselected neonates was 0.1%. The WPW pattern was more frequent in boys and generally not associated with structural heart disease, and the accessory pathways were primarily left-sided. At follow-up, the WPW pattern had disappeared in most of the children suggesting either an intermittent nature or that normalization occurs., Clinical Trial Registration: Copenhagen Baby Heart, NCT02753348., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Paciente masculino de 22 años quien ingresa por episodio de síncope. En el electrocardiograma se encuentra patrón de Wolff-Parkinson-White y signos de sobrecarga auricular e hipertrofia ventricular izquierda con bloqueo aurículo-ventricular completo. El ecocardiograma transtorácico es compatible con cardiomiopatía hipertrófica no obstructiva. Se lleva a estudio electrofisiológico donde se encuentra pre-excitación por vía accesoria y bloqueo aurículo-ventricular infrahisiano; se realiza ablación y se implanta marcapasos bicameral.A 22 years old male patient is admitted for a syncope episode. An electrocardiogram shows a Wolff-Parkinson-White pattern and signs of auricular overload with left ventricular hypertrophy and complete auriculoventricular block. The transthoracic echocardiogram is compatible with non-obstructive hypertrophic cardiomyopathy. An electrophysiological study is carried out, finding pre-excitation through an accessory way and infra-His auriculoventricular block. An ablation is performed and a bicameral pacemaker is implanted.

This essay is a brief review of advances in treatment of patients with supraventricular tachycardia (SVT) over the past 55 years. We review the knowledge base available in terms of arrhythmia diagnosis and the limited availability of drug therapy. Significant advances resulted in the introduction of direct-current defibrillators as well as introduction of ambulatory ECG recordings. We also witnessed a tremendous increase in an understanding of the mechanisms of SVT which in turn led to the development of first surgical and subsequently catheter based techniques for localization and ablation of foci or pathways responsible for arrhythmias. More recently, surgical and catheter techniques have been introduced in an attempt to cure atrial fibrillation. These techniques have proven especially effective for those with paroxysmal atrial fibrillation and less effective for those with long standing persistent fibrillation. The future brings hope for more extensive use of non-invasive techniques both to diagnose arrhythmia mechanisms together with techniques to ablate cardiac foci without patient instrumentation and finally in the use of gene therapy for patients with cardiac arrhythmia. [ABSTRACT FROM AUTHOR]

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Abstract: Concealed accessory pathways (APs) are considered benign as they can only sustain orthodromic atrioventricular re‐entrant tachycardia (ORT). We describe a unique case of a concealed posteroseptal AP where longitudinal surveillance following repeated failed ablation attempts due to abnormal coronary sinus (CS) anatomy revealed spontaneous development of manifest pre‐excitation. The pathway was ultimately ablated via the percutaneous epicardial approach. The potential for development of Wolff‐Parkinson‐White (WPW) syndrome in patients with concealed APs has implications for ongoing surveillance in these patients. [ABSTRACT FROM AUTHOR]

While ablation of accessory pathways is usually performed without 3D mapping system, we present a case where high-density mapping helps in illustrating the anatomical features of epicardial and oblique AP connections. [ABSTRACT FROM AUTHOR]

Wolff-Parkinson-White en un EKG que cumple criterios de Crecimiento Ventricular Derecho.

Purpose: To compare the efficacy, safety, and cost-effectiveness of a three-catheter approach with a conventional five-catheter approach for the mapping and ablation of supraventricular tachycardia in pediatric patients with Wolff-Parkinson-White Syndrome (WPW) and concealed accessory pathways (APs). Methods: A retrospective review from 2008 to 2012 of patients less than 21 years with WPW who underwent a three-catheter radiofrequency (RF) ablation of a left-sided AP (ablation, right ventricular [RV] apical, and coronary sinus [CS] decapolar catheters) was performed. The three-catheter group was compared to a control group who underwent a standard five-catheter (ablation, RV apical, CS decapolar, His catheter, and right atrial catheter) ablation for the treatment of left-sided WPW or concealed AP. Demographics, ablation outcomes, and costs were compared between groups. Results: Twenty-eight patients met inclusion criteria with 28 control patients. The groups did not differ in gender, age, weight, or body surface area. Locations of theAP on the mitral annulus were similar between the groups. All patients were ablated via transseptal approach. Note that 28 of 28 in the three-catheter group (100%) and 27 of 28 (96%) controls were acutely successfully ablated (P = 0.31). No complications were encountered. There was no difference in procedural time, time to loss of AP conduction, or number of RF applications. Use of the three-catheter technique resulted in a total savings of $2,465/case, which includes the $680 savings from using fewer catheters as well as the savings from a shortened procedure time. Conclusions: Ablation in patients withWPW and a left-sided AP can be performed using three catheters with similar efficacy and safety while offering significant cost savings compared to a conventional fivecatheter approach. [ABSTRACT FROM AUTHOR]

Wolff-Parkinson-White (WPW) syndrome is a common cause of supraventricular tachycardia that carries a risk of sudden cardiac death. To date, mutations in only one gene, PRKAG2, which encodes the 5'-AMP-activatedprotein kinase subunit γ-2, have been identified as causative for WPW. DNA samples from five members of a family with WPW were analyzed by exome sequencing. We applied recently designed prioritization strategies (VAAST/pedigree VAAST) coupled with an ontology-based algorithm (Phevor) that reduced the number of potentially damaging variants to 10: a variant in KCNE2 previously associated with Long QT syndrome was also identified. Of these 11 variants, only MYH6 p.E1885K segregated with the WPW phenotype in all affected individuals and was absent in 10 unaffected family members. This variant was predicted to be damaging by in silico methods and is not present in the 1,000 genome and NHLBI exome sequencing project databases. Screening of a replication cohort of 47 unrelated WPW patients did not identify other likely causative variants in PRKAG2 or MYH6. MYH6 variants have been identified in patients with atrial septal defects, cardiomyopathies, and sick sinus syndrome. Our data highlight the pleiotropic nature of phenotypes associated with defects in this gene. [ABSTRACT FROM AUTHOR]

Several observations and maneuvers in the electrophysiology (EP) laboratory are employed to identify whether retrograde ventriculoatrial conduction is via the atrioventricular (AV) node or an accessory pathway. Parahisian pacing is a unique maneuver where there is no change in the position of the catheter, the position of the stimulating electrode, nor the cycle length for pacing, but rather the pacing output is varied. The primary value for parahisian pacing is to distinguish between a septal accessory pathway and AV nodal conduction. However, more nuanced but just as reliable interpretation is possible to also help identify free-wall accessory pathways, intermittently conducting pathways, multiple accessory pathways, and various combinations of pathway and AV nodal retrograde conduction. In this review, we discuss the importance of correct technique and explain with examples some uncommon, yet instructive, findings when performing parahisian pacing. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the diagnosis and treatment of Wolff-Parkinson-White (WPW), a cardiac conduction system disorder characterized by abnormal accessory conduction pathways between the atria and the ventricles, in athletes. It shows that the diagnosis of WPW is confirmed through electrocardiography (ECG). It concludes that WPW accounts for at least 1% of sudden cardiac death (SCD) in athletes with a prevalence of at least 1 to 4.5 per 1,000 children and adults.

Wolff-Parkinson-White (WPW) syndrome presents with paroxysmal supraventricular tachycardia and ECG findings of short PR interval with delta wave. Sudden cardiac death can be the first symptom. Analysis of data of 45 patients aged ⩽10 years who underwent electrophysiological evaluation for WPW was performed. Thirty-three patients presented with tachycardia and four with syncope; eight were asymptomatic. Atrial fibrillation was induced in six patients, and it degenerated to ventricular fibrillation (VF) in two (1 of these patients was asymptomatic and the other had syncope); accessory pathway effective refractory period was ⩽180 ms in both. Ablation was performed in 30 patients; the success rate was 90% (27/30) and recurrence rate was 17% (5/30). Induction of VF in two patients suggests that the prognosis of WPW in early childhood is not without risk. All patients with WPW pattern should be assessed electrophysiologically and risk-stratified. Ablation in patients with risk factors can prevent sudden death. [ABSTRACT FROM AUTHOR]

Congenital left ventricle to coronary sinus fistula is a rare entity. We report a case of an infant with prenatal finding of left ventricle to right atrial shunt. The anatomy was defined by multi-modality imaging. Baseline electrocardiogram was notable for a Wolff-Parkinson-White pattern. He underwent successful catheter device closure of the left ventricle to coronary sinus fistula. The patient developed supraventricular tachycardia and underwent successful ablation of the accessory pathway.

Wolff-Parkinson-White (WPW) syndrome is the most common manifestation of ventricular pre-excitation syndrome and is mostly found in individuals with no structural heart disease. Although the risk of malignant arrhythmias is low, sudden cardiac death (SCD) as the first clinical manifestation of WPW syndrome is well documented, and atrial fibrillation (AF) with a rapid ventricular response is the main mechanism involved. Unfortunately, the signs of pre-excitation and arrhythmias are sometimes under-diagnosed and under-treated. We describe the case of a 31-year-old man who was admitted with an irregular wide complex tachycardia consistent with pre-excited AF, which was not promptly diagnosed, and who developed ventricular fibrillation (VF) after administration of atrioventricular (AV) nodal blockers, as a primary manifestation of WPW syndrome. Blocking the AV node in patients with pre-excited AF may increase the ventricular rate and potentially result in hemodynamic instability. Among patients with WPW syndrome who survive an episode of SCD, catheter ablation of the accessory pathway is the treatment of choice., (Copyright © 2022 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background Accessory pathways (APs) with intermittent preexcitation (IPX) are thought to be of lower risk, but there are reports of IPX patients presenting with rapidly conducted atrial fibrillation. Methods Retrospective study performed on patients with preexcitation who underwent an electro-physiological study (EPS). IPX was defined as loss of the delta wave on electrocardiogram prior to EPS. Patients with IPX were compared with those with persistent preexcitation (PPX) or suppression of the delta wave on exercise test (IPX-ET). Congenital heart disease and prior ablations were excluded. Results Of 328 patients with preexcitation, 41 (12.5%) had IPX. Patients with IPX or PPX were similar in age (12.9 years vs 13.0 years, P = 0.8) and AP location (left-sided 54% vs 50%, P = 0.7; septal 32% vs 35%, P = 0.4). Testing on isoproterenol was performed in 17 (41%) IPX and 41 (14%) PPX patients. Although IPX patients had a longer median refractory period compared to PPX patients (340 ms vs 310 ms, P = 0.001), the incidence of APs with refractory periods ≤250 ms was similar (10% vs 12%, P = 1.0). Exercise tests were performed on 208 patients and 24 (12%) had IPX-ET. Compared with IPX patients, IPX-ET had similar median AP refractory periods (320 ms, P = 0.4) and incidence of APs with refractory periods ≤250 ms (13%, P = 1.0). Conclusion Patients with IPX had longer AP refractory periods than those with PPX, but the incidence of pathways with refractory periods ≤250 ms was not significantly different. The finding of IPX on a baseline electrocardiogram does not rule out potentially high-risk pathways. [ABSTRACT FROM AUTHOR]

Abstract: Background: Pre-excitation syndromes can elicit electrocardiogram (ECG) abnormalities that are nearly identical to those associated with acute myocardial ischemia. In the presence of atypical symptoms, stable hemodynamics, and unremarkable levels of cardiac enzymes, the decision whether to subject these patients to coronary angiography, or even non-invasive testing, can be difficult. Objective: To understand that pre-excitation syndrome can mimic acute myocardial injury, but should not preclude a complete ischemic work-up. Case Report: A 53-year-old man with Wolff-Parkinson-White pattern and coronary artery disease risk factors presented with new-onset substernal chest pain. A baseline ECG was significant for hyperacute T waves. After refusing cardiac catheterization, he was admitted to the cardiac care unit for intravenous heparin and eptifibatide. Although his stay was unremarkable and resting echocardiogram showed normal contractility and valve function, treadmill stress testing was negative for ischemic change, but revealed ST-segment depression with maximum stress in the lateral precordial leads. This was thought to be a “false positive” secondary to his conduction abnormality. Conclusion: No reliable algorithm exists for making an ECG diagnosis of myocardial infarction in the presence of a pre-excitation syndrome. Similarly, current non-invasive modalities have limitations in detecting jeopardized myocardium. If acute or hyperacute injury is suspected, the patient should be emergently referred for cardiac catheterization. [Copyright &y& Elsevier]

The article presents a case study of a 31-year-old male with hypertension and esophageal varices who are presented for transjugular intrahepatic portosystemic shunt (TIPS) placement. It says that the medical history of the patient was important for Wolff-Parkinson-White (WPW) syndrome, scoliosis, and mental retardation. It says that prior to the surgery, the patient was administered with rocephin and platelets. It discusses the Bundle of Kent and the other medications administered to patient.

This article reviews the definition and treatment of Wolf-Parkinson White Syndrome (WPWS), the risk of pre-excited atrial fibrillation (AF) in WPWS, the importance of recognizing pre-excited AF in WPWS and emergency treatment. It discusses the importance of cardiac imagining in WPWS to assess cardiac structure, as mild Ebstein's anomaly, a rare congenital abnormality, can first present with arrhythmias and is a major risk for sudden cardiac death. This article addresses these issues in the context of a case study. [ABSTRACT FROM AUTHOR]