Identical twins with differing forms of ventricular pre-excitation.

Abstract

SUMMARY Identical 10-year-old twins, both with electrocardiograms showing a short PR interval and a normal QRS complex but with dramatically different electrophysiological characteristics, are described.One twin experienced episodes of rapid palpitation and on one occasion was resuscitated from ventricular fibrillation. An intracardiac electrophysiological study confirmed the presence of an atrioventricular nodal bypass tract and in addition revealed the presence of an accessory atrioventricular pathway, thus demonstrating that the patient had both the Lown-Ganong-Levine and Wolff-ParkinsonWhite syndromes. Re-entry tachycardia and atrial fibrillation, with a very rapid ventricular rate, were precipitated. After treatment with amiodarone, the patient became asymptomatic and a repeat study showed that the features of the atrioventricular nodal bypass tract were no longer present and though re-entry tachycardias using the accessory atrioventricular pathway could still be induced, their rates were slower than before treatment.The other twin, in spite of an identical surface electrocardiogram, was asymptomatic. An electrophysiological study showed the features of an atrioventricular nodal bypass tract but there was no evidence of additional atrioventricular accessory connections and a tachycardia could not be induced.The Lown-Ganong-Levine syndrome (1952) and the Wolff-Parkinson-White syndrome (1930) are both types of ventricular pre-excitation. The former results from an atrioventricular nodal bypass tract and the latter from an accessory atrioventricular pathway (Wellens, 1975).The purpose of this paper is to describe identical twins with differing forms of pre-excitation. Both have the surface and intracardiac electrophysiological features of an atrioventricular nodal bypass tract (Lown-Ganong-Levine syndrome). One twin has in addition, the features of a concealed accessory atrioventricular pathway (Wolff-Parkinson-White syndrome). In cases of ventricular pre-excitation, accessory atrioventricular connections of more than one type are sometimes present but this is only the second report of a patient with the surface electrocardiogram of the Lown-Ganong-Levine syndrome in whom an accessory atrioventricular pathway was disclosed by an intracardiac electrophysiological study (Massumi and Vera, 1971;Spurrell et al., 1973;Gallagher et al., 1976), and it is the first report of identical twins with proved atrioventricular nodal bypass tracts. The patients are identical, male, 10-year-old twins. They were born after an uncomplicated pregnancy and delivery but twin A was noticed to have an apical systolic murmur in infancy and this has persisted. Twin A had experienced frequent, brief episodes of rapid palpitation for some months before the incident which brought about his admission to hospital. At that time his father, a general practitioner, found that he had a heart rate of over 300 per minute; carotid sinus massage was ineffective and 2 hours later, after admission, an electrocardiogram showed atrial fibrillation with ...

Atrioventricular Nodal Re-entry Tachycardia in Identical Twins: A Case Report and Literature Review

“…A similar clinical scenario was reported by Bennett et al [ 11 ]. Here identical 10 year old male twins with identical surface electrocardiograms both experienced arrhythmia.…”

Paroxysmal Supraventricular Tachycardia in Identical Twins with the Same Left Lateral Accessory Pathways and Innocent Dual Atrioventricular Pathways

“…This article describes the PSVT caused by the identical accessory pathway locations in identical twins. [6][7][8] Similar AV nodal physiology was documented in both. Familial occurrence of Wolff-Parkinson-White syndrome has been well described as autosomal dominance, 3,5 but the exact position of the accessory pathways was not determined.…”

“…Familial occurrence of Wolff-Parkinson-White syndrome has been well described as autosomal dominance, 3,5 but the exact position of the accessory pathways was not determined. [6][7][8] Twin A has unidirectional retrograde left lateral accessory pathway and twin B had a manifest Kent pathway at the same position. In both, the accessory pathways and the AV reentrant tachycardia were eliminated after RF ablation.…”

“…1 Familial occurrence of accessory pathways in identical twins with differing sites of ventricular preexcitation have been reported. [2][3][4][5][6][7][8] An autosomal dominant pattern is proposed to be the inheritance pattern of accessory pathways. 3,5 We describe identical twins with the same left and innocent dual AV nodal lateral accessory pathways, suggesting genetic factors in their pathogenesis.…”

Isolated Wolff-Parkinson-White syndrome in identical twins

“…In older reports, 1 from the 1950s and 2 from the 1970s, the location of the accessory pathway has varied between twins, 12 or only 1 of the 2 twins had evidence of atrioventricular pre-excitation while the other was described as having Lown-Ganong-Levine syndrome with a short PR but no evidence of atrioventricular pre-excitation. 13 , 14 …”