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2017 FEB 25 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Fresh data on Peptide Proteins - Peptide Hormones are presented in a [...]

Byline: Takuro Misaki, Go Watanabe, Takashi Iwa, Yoh Watanabe, Keiichi Mukai, Masao Takahashi, Hiroshi Ohtake, Keiichi Yamamoto Abstract: Ebstein's anomaly is the most common congenital heart disease associated with the Wolff-Parkinson-White syndrome. Between November 1973 and March 1993, we surgically treated 42 patients with Wolff-Parkinson-White syndrome and Ebstein's anomaly. The patients' ages ranged from 5 months to 59 years (mean 35.3 [+ or -] 14.0 years). There were a total of 52 accessory pathways, 48 of which were located in the right (65%) or posteroseptal (29%) area. A left-sided accessory pathway was seen in only two patients (3.8%). Division of all right-sided accessory pathways was done during normothermic cardiopulmonary bypass with the heart beating; cryocoagulation was applied together with scalpel dissection of the atrioventricular groove. Division of the left-sided accessory pathways was done with the use of cold potassium cardioplegic arrest. Thirty-five of these patients underwent tricuspid valve operation for Ebstein's anomaly and 11 of them underwent tricuspid valve replacement with a bioprosthesis. All 52 accessory pathways were successfully divided, although two patients required reoperation because of tachycardia caused by accessory pathways in different positions. Three hospital deaths (7.1%) occurred. There were no late deaths during the follow-up period (mean 94.3 [+ or -] 52.4 months), but two patients required repeat tricuspid operation because of progression of the tricuspid regurgitation. Because no repeat operations were required during long-term follow-up in patients who underwent valve repair or valve replacement, correction should be indicated in some patients. (J THORAC CARDIOVASC SURG 1995;110:1702-7) Author Affiliation: Toyama and Kanazawa, Japan Article History: Received 10 February 1994; Accepted 6 April 1995 Article Note: (footnote) [star] From the Department of Surgery (1), Toyama Medical and Pharmaceutical University, Toyama, a and the Department of Surgery (1), Kanazawa University School of Medicine, Kanazawa, b Japan., [star][star] Address for reprints: Takuro Misaki, MD, Department of Surgery (1), Toyama Medical and Pharmaceutical University, Sugitani Toyama 2630, 930-01 Japan., a 0022-5223/95 $5.00 + 0, aa 12/1/65333

Wolff-Parkinson-White syndrome is the most common of the preexcitation syndromes and is due to an accessory pathway connecting the atria and ventricles. Asymptomatic patients do not require empirical therapy. Ongoing [...]

A predischarge electrophysiologic study was performed in 113 patients with the Wolff-Parkinson-White (WPW) syndrome who had undergone surgical ablation of the accessory pathway. The study was performed 5 to 20 (mean 10 [+ or -] 3) days after surgery. There were 82 male and 31 female patients (aged 4 to 58 years, mean 36 [+ or -] 13. Sixty-one patients (54%) had manifest, 52 (46%) had concealed and 12 (11%) had multiple accessory pathways. All but 1 patient had atrioventricular reentrant tachycardia incorporating single or multiple accessory pathways during the control electrophysiologic study. The accessory pathways were located in the left ventricular free wall in 60% of cases, right ventricular free wall in 22%, posteroseptum in 13%, and anteroseptum in 5%. The predischarge electrophysiologic study showed that the accessory pathway was capable of anterograde and retrograde conductions in 4 patients (all with manifest WPW syndrome). Four patients showed induction of supraventricular tachycardia, including 2 with atrioventricular reentrant tachycardia, and 2 with atrioventricular nodal reentrant tachycardia. Recurrence of supraventricular tachycardia was noted in 5 patients during a follow-up of 28 [+ or -] 26 months. Of these 5 patients, 2 had inducible and 3 had no inducible supraventricular tachycardia during the predischarge electrophysiologic study. Thus, the predischarge electrophysiologic study could predict late outcome with recurrence of preexcitation or supraventricular tachycardia in patients who had undergone surgical ablation of the accessory pathway with an overall predictive accuracy of 95% (107 of 113 patients), negative predictive value of 96% (103 of 107), and positive predictive value of 67% (4 of 6).

The management of atrial fibrillation (AF) with Wolff-Parkinson-White syndrome (WPWS) is complex and can result in significant morbidity and mortality if not correctly recognized and treated appropriately. We report the case of a 25-year-old male who presented to the Emergency Department (ED) with palpitations; his ECG revealed WPWS with AF. He underwent successful synchronized cardioversion and subsequent catheter ablation of the accessory bypass tract. Keywords: Wolff-Parkinson-White syndrome, atrial fibrillation, dysrhythmia, Table of Contents Abstract Case Report Discussion References Case Report A 25-year-old male presented to the emergency department complaining of palpitations associated with chest pressure, shortness of breath and sweating. [...]

In the normal heart, contraction of the atria and ventricles is controlled by a sequential pathway of electrical activity that induces cardiac muscular contraction. This electrical stimulation originates in a pacemaker region of the coronary sinus of the heart, and follows a well defined pathway to the atria and ventricles. Normal functioning of this pathway is evident when cardiac electrical activity is monitored (electrocardiogram). In patients suffering from Wolff-Parkinson-White syndrome, this normal pathway is disturbed; this disturbance manifests itself as a supraventricular tachycardia (excessively rapid contraction of the ventricle resulting from a too-rapid arrival of the electrical impulse at the ventricle). The electrocardiographic manifestation of this is known as preexcitation, and refers to the early arrival of the excitatory electrical impulse. The underlying cause of the preexcitation must be determined and corrected. In some cases, preexcitation results from the formation of an alternate pathway over which the electrical impulses travel. When this is the case, surgical destruction of the pathway is the treatment of choice. The preexcitation can be graded in severity, from minimal to extreme. To determine whether the extent of preexcitation can play a predictive role in ascertaining the location of alternate conduction pathways in Wolff-Parkinson-White syndrome patients, 131 patients with this condition (96 male and 35 female) between the ages of 10 and 68 years were evaluated. Twenty-seven of the patients (21 percent) were found to have a minimal preexcitation pattern. The vast majority of these patients (85 percent) were subsequently determined (at the time of surgery) to have a particular type of alternate pathway (left lateral accessory). Hence, minimal preexcitation appears to be a good predictor of patients who have left lateral accessory alternate conduction pathways. (Consumer Summary produced by Reliance Medical Information, Inc.)

The frequency of surgery to remedy Wolff-Parkinson-White syndrome (WPW), an abnormality in the electrical activity of the heart manifesting itself as a rapid heart beat (supraventricular tachycardia), has increased dramatically with the development of increasingly sophisticated electrophysiological monitoring technology. According to published reports, about 20 percent of the patients undergoing surgery for WPW syndrome have concurrent cardiac diseases that also require surgical repair. A case is presented in which a 31-year-old male patient was admitted to the hospital for increasingly rapid heartbeat with chest pains. The symptoms had begun approximately 15 years prior, and had recently gotten much more severe. Electrocardiographic diagnosis indicated WPW syndrome, and the patient was scheduled for surgery to destroy the region of the heart producing the aberrant electrical activity. Just prior to surgery, angiography (a radiological tool for visualizing the blood vessels) showed that in addition to the WPW syndrome, the patient had a 90 percent stenosis (occlusion) of one of the coronary arteries during systole (the period when the heart is undergoing contraction); this condition is known as myocardial bridging and causes a decrease in the blood supply to the heart. Because the chest pains and irregular rapid heartbeat continued, surgery was carried out. Cryoablation (destruction of tissue by the application of a very cold probe) of the area of the heart producing the electrical disturbance was performed. Postoperative electrocardiography and angiography indicated complete reversal of the myocardial bridging and WPW, and four months later the patient was free of symptoms. (Consumer Summary produced by Reliance Medical Information, Inc.)

Obstructive Sleep Apnea And Respiratory Failure (CHEST 1999; 116:1786-1793) Key words: adrenal cortical hyperplasia; cardiopulmonary interactions; Cushing's syndrome; Interventricular interactions; obstructive sleep apnea; respiratory failure; sudden death Abbreviations: CPAP = [...]

Synopsis: Young patients with inducible AV reentrant tachycardia or multiple accessory pathways should undergo ablation, if possible. Source: Pappone C, et al. N Engl J Med. 2003;349: 1803-1811. THE OPTIMAL [...]

The true prevalence of the Wolff-Parkinson-White syndrome is not known, but the typical findings of a short PR interval and a [delta] wave are seen in 1-3 per 1000 electrocardiograms, […]