Significance of annulus fibrosus of heart in relation to AV conduction and ventricular activation in cases of Wolff-Parkinson-White syndrome.

Lunel, A.

doi:10.1136/hrt.34.12.1263

Cited by 96 publications

(8 citation statements)

References 18 publications

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“…10 Defects in the annulus fibrosus are an explanation for the formation of accessory pathways on the right side of the heart around the tricuspid valve because these pathways traverse the annulus fibrosus and are usually subepicardial in location. 11 The final separation of the right atrium from the right ventricle is part of the normal postnatal development, 12 and it has been hypothesized that the basic morphogenetic abnormality of INVM is arrest of the normal process of compaction of the loose interwoven mesh of myocardial fibers in the embryo, 1 and that the normal process of development of the annulus fibrosus after birth is also arrested.…”

Section: Discussionmentioning

confidence: 99%

Wolff-Parkinson-White (WPW) Syndrome in Isolated Noncompaction of the Ventricular Myocardium (INVM)-Three Cases-

Nihei

Shinomiya

Kabayama

et al. 2004

Circ J

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solated noncompaction of the ventricular myocardium (INVM) is a rare disorder characterized by excessively prominent trabeculations and deep intertrabecular recesses, mainly in the left ventricle without other congenital cardiac malformations. 1 Most patients with INVM show various abnormalities on the electrocardiogram (ECG), including Wolff-Parkinson-White (WPW) syndrome, 2,3 which is currently classified into several types based on the localization of the bypass tract. It has not previously been reported which type of WPW syndrome occurs in patients with INVM. 3,4 We report 3 patients with INVM and WPW syndrome type B on ECG, which has not been previoulsy reported. 3,4 Case Reports Patient 1A 9-month-old Japanese girl was admitted to hospital because of increasing dyspnea. She was the first child of healthy nonconsanguineous parents, and the pregnancy and delivery had been uneventful.On admission, she was thin and malnourished: weight 6 kg and height 56 cm, both below the 10th percentile. She was pale and had cyanosis of the lips and nail bed. On auscultation, there was tachypnea and moderate retraction of the chest wall with moist rales over the entire lung field. A grade 3 pansystolic murmur was noted at the apex. Her abdomen was moderately distended, with the liver palpable 3 cm below the right costal margin. Chest X-ray showed marked cardiac enlargement, and pulmonary venous congestion. She died suddenly at 11 months of age. Patient 2The 6-month-old younger sister of Patient 1 was referred for examination of her cardiac function. The pregnancy and delivery had been uneventful and she was currently alert and healthy. Her heart sounds were clear and the rhythm was regular without murmur.Chest X-ray showed mild cardiac enlargement with a cardiothoracic ratio of 0.61. One year later, she still did not have symptoms, but her cardiac performance had deteriorated slightly, with a left ventricular fractional shortening (LVFS) of 24% and an ejection fraction (LVEF) of 57%. She was treated with oral angiotensin-converting enzyme inhibitor. Patient 3A 9-year-old girl was referred for an outpatient examination of an arrhythmia diagnosed previously during a school physical examination. She was alert and healthy with clear heart sounds and no murmur. No cardiac enlargement was noted on the chest roentgenogram. Electrocardiography, Echocardiography and Magnetic Resonance ImagingThe ECG of Patient 1 revealed marked tachycardia of 150 beats/min and WPW syndrome type B, with localization of the accessory pathway in the right anteroseptal area (Fig 1A). Cardiac performance was markedly depressed. A 2-dimensional (D) echocardiogram (Fig 1B) and a T1-weighted magnetic resonance imaging (MRI) scan (Fig 1C) revealed numerous, excessively prominent ventricular trabeculations and deep intertrabecular recesses, but there was no evidence of endocardial thrombus over the left ventricular wall.The ECG from Patient 2 revealed a normal sinus rhythm and WPW syndrome type B, with localization of the accessory pathway in the right anteros...

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Section: Discussionmentioning

confidence: 99%

Wolff-Parkinson-White (WPW) Syndrome in Isolated Noncompaction of the Ventricular Myocardium (INVM)-Three Cases-

Nihei

Shinomiya

Kabayama

et al. 2004

Circ J

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“…These pathways are generally felt to consist of strands of working myocardium joining atria and ventricle.25 29 It is possible that individual muscle strands may have nonhomogeneous physiologic properties or that several strands making up an accessory pathway may be capable of longitudinal dissociation. It is also possible that some accessory pathways are composed of tissue other than working myocardium.…”

Section: Sudden Prolongation Of Ventriculoatrialap Conduction Time Inmentioning

confidence: 99%

Atypical patterns of retrograde conduction over accessory atrioventricular pathways in the Wolff-Parkinson-White syndrome.

Klein¹,

Prystowsky²,

Pritchett³

et al. 1979

Circulation

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Patterns of ventriculoatrial conduction have been used to distinguish retrograde conduction over an accessory atrioventricular pathway from that over the normal atrioventricular conduction system. Ventriculoatrial conduction at a constant interval during incremental ventricular pacing and during progressive prematurity of ventricular extrastimuli has been considered characteristic of conduction over an accessory pathway. We describe three patients with the Wolff-Parkinson-White syndrome who had progressive or sudden increments in ventriculoatrial conduction over an accessory pathway during fixed-rate ventricular pacing or during introduction of ventricular extrastimuli. Such properties have been considered characteristic of conduction over the normal atrioventricular conduction system. We conclude that retrograde conduction over accessory pathways may resemble conduction over the normal atrioventricular conduction system.

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“…[23][24][25] In case 1, the atrial activation sequence during retrograde conduction was consistent with a septal location, showing atrial activation on the HBE which preceded low lateral RA and lateral LA activity recorded from the coronary sinus. This same sequence was observed during PAT.…”

Section: Discussionmentioning

confidence: 99%

An Electrophysiologic Approach to the Surgical Treatment of the Wolff-Parkinson-White Syndrome

et al. 1974

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SUMMARYThe usefulness and limitations of electrode catheter and epicardial mapping techniques in the evaluation of the Wolff-Parkinson-White syndrome are described. In one case epicardial surface mapping was unsuccessful in localizing the accessory connection. However, a septal location was suggested by catheter recording techniques and confirmed by the point at which the surgical incision interrupted the accessory connection. In the second case catheter techniques could not confirm the role of the accessory connection in a re-entrant rhythm. Epicardial mapping of the atrium during PAT confirmed a return route to the atrium over the accessory connection, opposite the point of ventricular pre-excitation during sinus rhythm. In both cases, following surgery, epicardial maps, 12-lead ECGs and catheter recording techniques revealed no evidence of residual pre-excitation. Additional Indexing Words:His bundle electrocardiography Coronary sinus recordings TECHNIQUES which employ electrode catheters have been described for evaluating patients with the Wolff-Parkinson-White syndrome; and useful criteria have been established for demonstrating anomalous ventricular pre-excitation,'-5 mechanisms of tachycardia,6-" the location of the accessory connection,4 7 10 and the properties of anomalous atrioventricular conduction.2' 10 Epicardial mapping has been utilized to verify anomalous ventricular pre-excitation"-2 and to localize the accessory connection for surgical interruption. [13][14][15][16][17][18][19][20][21][22][23][24] In several instances we have had the opportunity to combine electrophysiologic observations using catheter techniques and intraoperative mapping in the same patient. Two patients with the WolffParkinson-White syndrome were of particular interest because these two approaches provided complementary data which were essential to their treatment. In the first patient an accessory connection within the From Supraventricular tachycardia Retrograde ventriculo-atrial conductionPre-excitation septum, suggested by catheter data but not evident from epicardial mapping, was successfully divided at surgery. In a second patient, we were unable to delineate the site of the accessory pathway or to initiate tachycardia during the preoperative study. However, the location of the pathway between the left atrium and ventricle and its participation in the tachycardia were determined at surgery prior to its successful division.Case 1 M.R. was a 47-year-old female with a history of tachycardia beginning at age 16. In 1969 episodes of tachycardia recurred more frequently and were accompanied by nausea, lightheadedness and tightness in the chest. During one such episode, supraventricular tachycardia was documented. Following conversion to sinus rhythm, the electrocardiogram revealed right bundle branch block. On alternate beats the PR interval shortened in association with delta waves compatible with ventricular pre-excitation. Treatment with digitalis and quinidine was instituted, but had to be discontinued because of into...

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Significance of annulus fibrosus of heart in relation to AV conduction and ventricular activation in cases of Wolff-Parkinson-White syndrome.

Cited by 96 publications

References 18 publications

Wolff-Parkinson-White (WPW) Syndrome in Isolated Noncompaction of the Ventricular Myocardium (INVM)-Three Cases-

Wolff-Parkinson-White (WPW) Syndrome in Isolated Noncompaction of the Ventricular Myocardium (INVM)-Three Cases-

Atypical patterns of retrograde conduction over accessory atrioventricular pathways in the Wolff-Parkinson-White syndrome.

An Electrophysiologic Approach to the Surgical Treatment of the Wolff-Parkinson-White Syndrome

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