Adverse effects of Wolff-Parkinson-White syndrome with right septal or posteroseptal accessory pathways on cardiac function

Tomaske, Maren; Janoušek, Jan; Rázek, Vít; Gebauer, Roman; Tomek, Viktor; Hindricks, G; Knirsch, Walter; Bauersfeld, Urs

doi:10.1093/europace/eun005

Cited by 112 publications

(126 citation statements)

References 35 publications

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“…Interestingly, left ventricular dysfunction because of abnormal ventricular activation has been found to be fully reversible in pediatric patients, either spontaneously, due to loss of preexcitation, or by ablation. 26 However, whether left ventricular dysfunction, and thereby potentially HF, as a result of preexcitation is fully reversible in adult patients remains elusive. A recent study using ECGgated cardiac computed tomography on adult patients with WPW suggested irreversible myocardial damage reflecting long-term effects of dyskinesia.…”

Section: Discussionmentioning

confidence: 99%

Electrocardiographic Preexcitation and Risk of Cardiovascular Morbidity and Mortality

Skov

Rasmussen

Ghouse

et al. 2017

Circ: Arrhythmia and Electrophysiology

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Background— The majority of available data on the clinical course of patients with ventricular preexcitation in the ECG originates from tertiary centers. We aimed to investigate long-term outcomes in individuals from a primary care population with electrocardiographic preexcitation. Methods and Results— Digital ECGs from 328 638 primary care patients were collected during 2001 to 2011. We identified 310 individuals with preexcitation (age range, 8–85 years). Data on medication, comorbidity, and outcomes were collected from Danish nationwide registries. The median follow-up time was 7.4 years (quartiles, 4.6–10.3 years). Compared with the remainder of the population, patients with preexcitation had higher adjusted hazards of atrial fibrillation (hazard ratio [HR], 3.12; 95% confidence interval [CI], 2.07–4.70) and heart failure (HR, 2.11; 95% CI, 1.27–3.50). Subgroup analysis on accessory pathway location revealed a higher adjusted hazard of heart failure for a right anteroseptal accessory pathway (HR, 5.88; 95% CI, 2.63–13.1). There was no evidence of a higher hazard of death among individuals with preexcitation when looking across all age groups (HR, 1.07; 95% CI, 0.68–1.68). However, a statistically significant ( P =0.01) interaction analysis (<65 versus ≥65 years) indicated a higher hazard of death for patients with preexcitation ≥65 years (HR, 1.85; 95% CI, 1.07–3.18). Conclusions— In this large ECG study, individuals with preexcitation had higher hazards of atrial fibrillation and heart failure. The higher hazard of heart failure seemed to be driven by a right anteroseptal accessory pathway. Among elderly people, we found a statistically significant association between preexcitation and a higher hazard of death.

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Section: Discussionmentioning

confidence: 99%

Electrocardiographic Preexcitation and Risk of Cardiovascular Morbidity and Mortality

Skov

Rasmussen

Ghouse

et al. 2017

Circ: Arrhythmia and Electrophysiology

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“…A previous study showed that patients with right septal or postero-septal accessory pathways presented with abnormal intraventricular septal wall motion, as compared with left-sided accessory pathways that resulted in abnormal LV posterior wall motion. 13) Left ventricular wall motion and the degree of dyssynchrony most likely are dependent upon the location of the accessory pathway.…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency Catheter Ablation of the Accessory Pathway Adversely Affected the Left Ventricular Outflow Tract Pressure Gradient in a Patient With Hypertrophic Obstructive Cardiomyopathy

et al. 2013

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SummaryAlthough hypertrophic cardiomyopathy (HCM) with an accessory pathway is encountered in clinical practice, there is little evidence of a coherent strategy for ablation of the accessory pathway in patients with HCM. We present the case of a 61-year-old man who had type B Wolff-Parkinson-White (WPW) syndrome with hypertrophic obstructive cardiomyopathy (HOCM). Due to paroxysmal atrial fibrillation, he underwent radiofrequency catheter ablation of the accessory pathway located in the right postero-lateral wall to prevent secondary symptomatic events. His LV dyssynchrony improved after the procedure, but the degree of the LV outflow tract (LVOT) pressure gradient was increased. To stabilize the LVOT pressure gradient, he needed additional medications. This case shows that patients with HOCM should be carefully evaluated before making a decision concerning ablation of the accessory pathway. ( 1,2) Radiofrequency catheter ablation (RFA) of the accessory pathway is acceptable first-time therapy for symptomatic WPW syndrome. On the other hand, hypertrophic obstructive cardiomyopathy (HOCM), which is characterized by LV outflow obstruction due to hypertrophy, predisposes the patients to hemodynamic collapse and thereby to a severe LV outflow tract (LVOT) pressure gradient.3) Although a previous report showed that 5% of patients with hypertrophic cardiomyopathy (HCM) had ventricular pre-excitation, the comorbidity of WPW syndrome and HOCM is rarely encountered in clinical practice.4) Patients with HOCM, generally, should be controlled with relative bradycardia, because the LV diastolic volume will be relatively increased and, accordingly, the LVOT pressure gradient will be relieved. In this regard, if they have an accessory pathway and experience AF, RFA is recommended for suppression of tachyarrhythmia. However, while deletion of the accessory pathway improves LV dyssynchrony, it may adversely affect the LVOT pressure gradient. There are some reports showing that the pressure gradient of HOCM is ameliorated by dual chamber pacing with short atrioventricular delay, which leads to LV dyssynchronous contraction. 5,6) In this regard, LV dyssynchrony might be required to relieve the LVOT pressure gradient of HOCM. We present a patient with both WPW syndrome and HOCM in whom the LVOT pressure gradient was affected by RFA. Case ReportA 61-year-old man with no remarkable past medical history was brought to our hospital because of a pre-syncopal episode. He had felt chest discomfort and faintness about 30 minutes after lunch. His vital signs were stable and the symptoms had disappeared at the time of consultation. On physical examination, a systolic murmur was maximally audible from the middle left sternal border. There was no pitting edema in the lower extremities, and no abnormality in the neurological findings. Although most of his laboratory data were normal, his blood level of B-type natriuretic peptide (BNP) was high (325 pg/mL). A 12-lead electrocardiogram (ECG) showed a profound high-voltage of R wave (S wave in V1 ...

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“…However, there have been some reports of decreased cardiac function in patients with WPW in the absence of SVT, and these patients (most of whom were infants or children) tend to exhibit segmental dyskinesia of the myocardium and/or global LV dysfunction. [7][8][9][10][11] Pre-existing areas may lead to dyssynchrony in LV motion and result in global LV dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…In those reports, most patients exhibited right septal or posteroseptal accessory pathways. [7][8][9][10][11] with WPW syndrome with a right-sided free-wall accessory pathway and dilated cardiomyopathy (DCM), in which LV function improved following RF ablation. 12) In patients with decreased LV cardiac function, such as those with DCM, LV dyssynchrony can further compromise cardiac function.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6] Recently, an accessory pathway has been reported to contribute to LV septal dyskinesia and LV dysfunction in the absence of documented SVT. [7][8][9][10][11] Many patients exhibit right septal or posteropesptal accessory pathways. Herein, we report a case of WPW syndrome with right-sided free-wall accessory pathway and LV dysfunction.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

An Asymptomatic Case of Wolff‐Parkinson‐White Syndrome with Right‐sided Free‐wall Accessory Pathway and Left Ventricular Dysfunction

Mine

Kodani

Hamaoka

et al. 2011

Journal of Arrhythmia

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A 16-year-old girl with a known history of asymptomatic Wolff-Parkinson-White syndrome exhibited signs of left ventricular (LV) septal akinesia and LV dysfunction during routine follow-up. A 12-lead surface ECG showed pre-excitation, a predominantly negative delta wave in V 1 and left axis deviation, which was consistent with the presence of a right free-wall accessory pathway. Radiofrequency ablation of the anterolateral right atrium around the local shortest atrium-to-ventricle interval created the accessory pathway block. An echocardiogram taken one month after the procedure revealed that LV septal wall motion had normalized and that LV ejection fraction had improved from 50% before the ablation to 64% after the ablation. Most previous reports of asymptomatic patients of WPW with LV septal dyskinesia and dysfunction have described right septal or posteroseptal accessory pathways. This patient reported here represents a rare case with right free-wall accessory pathway and LV dysfunction without tachycardia. (J Arrhythmia 2011; 27: 145-149)

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Adverse effects of Wolff-Parkinson-White syndrome with right septal or posteroseptal accessory pathways on cardiac function

Cited by 112 publications

References 35 publications

Electrocardiographic Preexcitation and Risk of Cardiovascular Morbidity and Mortality

Electrocardiographic Preexcitation and Risk of Cardiovascular Morbidity and Mortality

Radiofrequency Catheter Ablation of the Accessory Pathway Adversely Affected the Left Ventricular Outflow Tract Pressure Gradient in a Patient With Hypertrophic Obstructive Cardiomyopathy

An Asymptomatic Case of Wolff‐Parkinson‐White Syndrome with Right‐sided Free‐wall Accessory Pathway and Left Ventricular Dysfunction

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