Patterns and mechanisms of QRS normalization in patients with Wolff-Parkinson-White syndrome

Massumi, Rashid A.; Vera, Zakauddin

doi:10.1016/0002-9149(71)90096-8

Cited by 32 publications

(4 citation statements)

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“…Presence of the accessory atrioventricular pathway was concealed during sinus rhythm and it required very short cycle lengths to cause slight but sufficient prolongation of atrioventricular nodal bypass tract conduction so that it was slower than conduction along the accessory atrioventricular pathway and hence led to the appearance of delta waves. A similar case has been reported by Massumi and Vera (1971). One possibility to be considered is that the delta waves were the result of Mahaim fibres since an accessory atrioventricular pathway can be mimicked by a combination of an atrioventricular nodal bypass tract and Mahaim fibres (Brechenmacher et al, 1976).…”

Section: Discussionmentioning

confidence: 63%

“…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.…”

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confidence: 91%

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Identical twins with differing forms of ventricular pre-excitation.

Bennett¹,

Gribbin²,

Birkhead³

1978

Heart

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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 ...

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Section: Discussionmentioning

confidence: 63%

mentioning

confidence: 91%

Identical twins with differing forms of ventricular pre-excitation.

Bennett¹,

Gribbin²,

Birkhead³

1978

Heart

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“…The delta wave can be abol ished by any intervention which slows conduction in the accessory path way or has an opposite effect on the atrioventricular conduction [4,6].…”

mentioning

confidence: 99%

Normalization of the QRS Complex by Concealed Conduction in a Patient with Wolff-Parkinson-White Syndrome

Schweitzer¹,

Mark²

1978

Cardiology

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“…The type of W-P-W syndrome is not helpful since we have encountered, among 21 cases studied,'4 "Kent bundle" alone, or "Kent bundle plus James fibers,"' or "James fibers plus Mahaim fibers" disposition (table 1) in any type of W-P-W syndrome. In the reverse, the evaluation of the "functional" disposition of accessory pathways does not allow precise anatomic conclusions, except for cases in which epicardial potentials or even the accessory path itself9' 16 …”

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confidence: 99%

Wolff-Parkinson-White Syndrome

et al. 1972

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Total atrioventricular bypass (Kent bundle) does not explain all the findings in some cases of Wolff-Parkinson-White (W-P-W) syndrome. Two cases are reported in which two accessory pathways, set in series or in parallel, could be demonstrated. In case 1, a short P-R interval, gap phenomenon, and presence of delta wave with either a short or long P-R interval suggested the hypothesis of an atrio-His accessory path (James fibers). The presence of a type-B delta wave during His stimulation demonstrated the takeoff of another bypass (Mahaim fibers) below or at the point of stimulation. The His-ventricle accessory path had a supernormal phase of conduction during either atrial or His stimulation. In case 2, the rapid spread of the impulse to the His bundle (P-H 65 msec) was responsible for a normal H-R interval (35 msec) during either reciprocating tachycardia or normal sinus rhythm wtih a nonwidened QRS and minimal W-P-W deformity (partial cancellation of the delta wave). During reciprocating tachycardia, alternatively short and long P'-H intervals with constant H-R (His bundle) and R-P' (Kent bundle) were due to alternate antegrade atrio-His conduction through the atrionodal bypass (James fibers) and the A-V node. Surgical findings confirmed the existence of a left bundle of Kent. The division of the His bundle resulted in a maximal W-P-W deformity (type A) and abolished the reciprocating tachycardia.

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Patterns and mechanisms of QRS normalization in patients with Wolff-Parkinson-White syndrome

Cited by 32 publications

References 28 publications

Identical twins with differing forms of ventricular pre-excitation.

Identical twins with differing forms of ventricular pre-excitation.

Normalization of the QRS Complex by Concealed Conduction in a Patient with Wolff-Parkinson-White Syndrome

Wolff-Parkinson-White Syndrome

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