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Heidbuchel H, Adami PE, Antz M, Braunschweig F, Delise P, Scherr D, Solberg EE, Wilhelm M, Pelliccia A. Recommendations for participation in leisure-time physical activity and competitive sports in patients with arrhythmias and potentially arrhythmogenic conditions: Part 1: Supraventricular arrhythmias. A position statement of the Section of Sports Cardiology and Exercise from the European Association of Preventive Cardiology (EAPC) and the European Heart Rhythm Association (EHRA), both associations of the European Society of Cardiology. Eur J Prev Cardiol 2021; 28:1539-1551. [PMID: 32597206 DOI: 10.1177/2047487320925635] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 01/02/2023]
Abstract
Symptoms attributable to arrhythmias are frequently encountered in clinical practice. Cardiologists and sport physicians are required to identify high-risk individuals harbouring such conditions and provide appropriate advice regarding participation in regular exercise programmes and competitive sport. The three aspects that need to be considered are: (a) the risk of life-threatening arrhythmias by participating in sports; (b) control of symptoms due to arrhythmias that are not life-threatening but may hamper performance and/or reduce the quality of life; and (c) the impact of sports on the natural progression of the underlying arrhythmogenic condition. In many cases, there is no unequivocal answer to each aspect and therefore an open discussion with the athlete is necessary, in order to reach a balanced decision. In 2006 the Sports Cardiology and Exercise Section of the European Association of Preventive Cardiology published recommendations for participation in leisure-time physical activity and competitive sport in individuals with arrhythmias and potentially arrhythmogenic conditions. More than a decade on, these recommendations are partly obsolete given the evolving knowledge of the diagnosis, management and treatment of these conditions. The present document presents a combined effort by the Sports Cardiology and Exercise Section of the European Association of Preventive Cardiology and the European Heart Rhythm Association to offer a comprehensive overview of the most updated recommendations for practising cardiologists and sport physicians managing athletes with supraventricular arrhythmias, and provides pragmatic advice for safe participation in recreational physical activities, as well as competitive sport at amateur and professional level. A companion text on recommendations in athletes with ventricular arrhythmias, inherited arrhythmogenic conditions, pacemakers and implantable defibrillators is published as Part 2 in Europace.
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Affiliation(s)
- Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp, Belgium
| | - Paolo E Adami
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Italy
| | - Matthias Antz
- Department of Electrophysiology, Hospital Braunschweig, Germany
| | | | | | - Daniel Scherr
- Department of Medicine, Medical University of Graz, Austria
| | | | | | - Antonio Pelliccia
- Italian National Olympic Committee, Institute of Sport Medicine and Science, Italy
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2
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Guía ESC 2020 sobre cardiología del deporte y el ejercicio en pacientes con enfermedad cardiovascular. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Brugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ, Blomström-Lundqvist C, Calkins H, Corrado D, Deftereos SG, Diller GP, Gomez-Doblas JJ, Gorenek B, Grace A, Ho SY, Kaski JC, Kuck KH, Lambiase PD, Sacher F, Sarquella-Brugada G, Suwalski P, Zaza A. 2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J 2021; 41:655-720. [PMID: 31504425 DOI: 10.1093/eurheartj/ehz467] [Citation(s) in RCA: 522] [Impact Index Per Article: 174.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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4
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Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, Collet JP, Corrado D, Drezner JA, Halle M, Hansen D, Heidbuchel H, Myers J, Niebauer J, Papadakis M, Piepoli MF, Prescott E, Roos-Hesselink JW, Graham Stuart A, Taylor RS, Thompson PD, Tiberi M, Vanhees L, Wilhelm M. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J 2021; 42:17-96. [PMID: 32860412 DOI: 10.1093/eurheartj/ehaa605] [Citation(s) in RCA: 728] [Impact Index Per Article: 242.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Volpato G, Falanga U, Cipolletta L, Conti MA, Grifoni G, Ciliberti G, Urbinati A, Barbarossa A, Stronati G, Fogante M, Bergonti M, Catto V, Guerra F, Giovagnoni A, Dello Russo A, Casella M, Compagnucci P. Sports Activity and Arrhythmic Risk in Cardiomyopathies and Channelopathies: A Critical Review of European Guidelines on Sports Cardiology in Patients with Cardiovascular Diseases. ACTA ACUST UNITED AC 2021; 57:medicina57040308. [PMID: 33805943 PMCID: PMC8064370 DOI: 10.3390/medicina57040308] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/10/2021] [Accepted: 03/16/2021] [Indexed: 12/27/2022]
Abstract
The prediction and prevention of sudden cardiac death is the philosopher’s stone of clinical cardiac electrophysiology. Sports can act as triggers of fatal arrhythmias and therefore it is essential to promptly frame the athlete at risk and to carefully evaluate the suitability for both competitive and recreational sports activity. A history of syncope or palpitations, the presence of premature ventricular complexes or more complex arrhythmias, a reduced left ventricular systolic function, or the presence of known or familiar heart disease should prompt a thorough evaluation with second level examinations. In this regard, cardiac magnetic resonance and electrophysiological study play important roles in the diagnostic work-up. The role of genetics is increasing both in cardiomyopathies and in channelopathies, and a careful evaluation must be focused on genotype positive/phenotype negative subjects. In addition to being a trigger for fatal arrhythmias in certain cardiomyopathies, sports also play a role in the progression of the disease itself, especially in the case arrhythmogenic right ventricular cardiomyopathy. In this paper, we review the latest European guidelines on sport cardiology in patients with cardiovascular diseases, focusing on arrhythmic risk stratification and the management of cardiomyopathies and channelopathies.
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Affiliation(s)
- Giovanni Volpato
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (A.U.); (A.B.); (G.S.); (F.G.); (A.D.R.); (P.C.)
- Correspondence:
| | - Umberto Falanga
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (A.U.); (A.B.); (G.S.); (F.G.); (A.D.R.); (P.C.)
| | - Laura Cipolletta
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (A.U.); (A.B.); (G.S.); (F.G.); (A.D.R.); (P.C.)
| | - Manuel Antonio Conti
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (A.U.); (A.B.); (G.S.); (F.G.); (A.D.R.); (P.C.)
| | - Gino Grifoni
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (A.U.); (A.B.); (G.S.); (F.G.); (A.D.R.); (P.C.)
| | - Giuseppe Ciliberti
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (A.U.); (A.B.); (G.S.); (F.G.); (A.D.R.); (P.C.)
| | - Alessia Urbinati
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (A.U.); (A.B.); (G.S.); (F.G.); (A.D.R.); (P.C.)
| | - Alessandro Barbarossa
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (A.U.); (A.B.); (G.S.); (F.G.); (A.D.R.); (P.C.)
| | - Giulia Stronati
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (A.U.); (A.B.); (G.S.); (F.G.); (A.D.R.); (P.C.)
| | - Marco Fogante
- Department of Radiology, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (M.F.); (A.G.)
| | - Marco Bergonti
- Department of Clinical Sciences and Community Health, University of Milan, 20100 Milan, Italy;
| | - Valentina Catto
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, 20100 Milan, Italy;
| | - Federico Guerra
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (A.U.); (A.B.); (G.S.); (F.G.); (A.D.R.); (P.C.)
| | - Andrea Giovagnoni
- Department of Radiology, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (M.F.); (A.G.)
| | - Antonio Dello Russo
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (A.U.); (A.B.); (G.S.); (F.G.); (A.D.R.); (P.C.)
| | - Michela Casella
- Department of Clinical, Special and Dental Sciences, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy;
| | - Paolo Compagnucci
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (A.U.); (A.B.); (G.S.); (F.G.); (A.D.R.); (P.C.)
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Clinical Approach to Symptomatic and Asymptomatic Patients with Ventricular Pre-excitation. Card Electrophysiol Clin 2020; 12:527-539. [PMID: 33162001 DOI: 10.1016/j.ccep.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Despite extensive knowledge of the physiopathology of ventricular pre-excitation, management of asymptomatic patients with this condition remains controversial.
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Artificial Intelligence Applications to Improve Risk Prediction Tools in Electrophysiology. CURRENT CARDIOVASCULAR RISK REPORTS 2020. [DOI: 10.1007/s12170-020-00649-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Babayiğit E, Ulus T, Görenek B. What Have We Learned from the European Society of Cardiology 2019 Guidelines on Supraventricular Tachycardia. Cardiology 2020; 145:492-503. [DOI: 10.1159/000508264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/22/2020] [Indexed: 11/19/2022]
Abstract
Supraventricular tachycardias (SVTs) are common arrhythmic conditions in clinical practice. Increased knowledge and experience on SVTs and some unclear situations in clinical practice led the European Society of Cardiology (ESC) team to write a new guideline. In this review, we touch upon the important points in the new ESC 2019 SVT guidelines and present changing approaches and suggestions. By providing a general review on SVTs, we also mention the basic mechanism, epidemiology, and clinical presentation of SVTs, approaching narrow and wide QRS tachycardias, SVTs in special patient groups, and treatment of SVTs.
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LaRocca TJ, Beyersdorf GB, Li W, Foltz R, Patel AR, Tanel RE. Comparison of Electrophysiologic Profiles in Pediatric Patients with Incidentally Identified Pre-Excitation Compared with Wolff-Parkinson-White Syndrome. Am J Cardiol 2019; 124:389-395. [PMID: 31204032 DOI: 10.1016/j.amjcard.2019.04.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/19/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
The rising utilization of screening electrocardiograms has resulted in increased incidental identification of ventricular pre-excitation in pediatric patients. We compared accessory pathways of incidentally identified pre-excitation to Wolff-Parkinson-White Syndrome (WPW) with the aim to identify factors important in preprocedural counseling and planning. This single-center, retrospective study of patients ≤18 years without congenital heart disease identified 227 patients diagnosed with pre-excitation and referred for invasive electrophysiology study between 2008 and 2017. WPW Syndrome was diagnosed in 178 patients, while 49 patients had incidental identification of pre-excitation. Anterograde conduction of incidentally identified accessory pathways was not clinically different between the two cohorts at baseline or upon isoproterenol infusion. However, the proportion of accessory pathways meeting high-risk criteria was significantly lower than in patients diagnosed with WPW, 12% versus 28% (p < 0.05). Retrograde conduction at baseline of incidentally diagnosed accessory pathways was slower with a median block cycle length 365 milliseconds (IQR 260 to 450) versus 290 milliseconds (IQR 260 to 330, p < 0.01). In the incidentally identified cohort, right-sided, paraHisian, and fascicular pathways were more common with fewer attempted ablations (71% vs 94%, p < 0.001) and lower success rate (91% vs 97%, p < 0.001). A binomial logistic regression analysis further indicated patients incidentally identified with pre-excitation were associated with having lower rates of inducible supraventricular tachycardia, atrial fibrillation, and ablations performed, in addition, to having right-sided pathways. In conclusion, as patients with incidentally identified pre-excitation present more frequently for consideration of invasive electrophysiology study, these results impact procedural approaches, technical considerations, patient counseling, and outcome expectations.
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Brugada J, Keegan R. Asymptomatic Ventricular Pre-excitation: Between Sudden Cardiac Death and Catheter Ablation. Arrhythm Electrophysiol Rev 2018; 7:32-38. [PMID: 29636970 DOI: 10.15420/aer.2017.51.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Debate about the best clinical approach to the management of asymptomatic patients with ventricular pre-excitation and advice on whether or not to invasively stratify and ablate is on-going. Weak evidence about the real risk of sudden cardiac death and the potential benefit of catheter ablation has probably prevented the clarification of action in this not infrequent and sometimes conflicting clinical situation. After analysing all available data, real evidence-based medicine could be the alternative strategy for managing this group of patients. According to recent surveys, most electrophysiologists invasively stratify. Based on all accepted risk factors - younger age, male, associated structural heart disease, posteroseptal localisation, ability of the accessory pathway to conduct anterogradely at short intervals of ≤250 milliseconds and inducibility of sustained atrioventricular re-entrant tachycardia and/or atrial fibrillation - a shared decisionmaking process on catheter ablation is proposed.
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Affiliation(s)
- Josep Brugada
- Cardiovascular Institute, Hospital Clinic and Paediatric Arrhythmia Unit, Hospital Sant Joan de Déu, University of BarcelonaBarcelona, Spain
| | - Roberto Keegan
- Electrophysiology Service, Private Hospital of the SouthBahia Blanca, Argentina
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Etheridge SP, Escudero CA, Blaufox AD, Law IH, Dechert-Crooks BE, Stephenson EA, Dubin AM, Ceresnak SR, Motonaga KS, Skinner JR, Marcondes LD, Perry JC, Collins KK, Seslar SP, Cabrera M, Uzun O, Cannon BC, Aziz PF, Kubuš P, Tanel RE, Valdes SO, Sami S, Kertesz NJ, Maldonado J, Erickson C, Moore JP, Asakai H, Mill L, Abcede M, Spector ZZ, Menon S, Shwayder M, Bradley DJ, Cohen MI, Sanatani S. Life-Threatening Event Risk in Children With Wolff-Parkinson-White Syndrome. JACC Clin Electrophysiol 2018; 4:433-444. [DOI: 10.1016/j.jacep.2017.10.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/03/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
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Abstract
Risk stratification of patients with Wolff-Parkinson-White syndrome for sudden death is a complex process, particularly in understanding the utility of the repeat exercise stress test. We report a case of an 18-year-old patient who was found to have a high-risk pathway by both invasive and exercise stress testing after an initial exercise stress test showing beat-to-beat loss of pre-excitation.
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Abstract
The Wolff-Parkinson-White pattern refers to the electrocardiographic appearance in sinus rhythm, wherein an accessory atrioventricular pathway abbreviates the P-R interval and causes a slurring of the QRS upslope - the "delta wave". It may be asymptomatic or it may be associated with orthodromic reciprocating tachycardia; however, rarely, even in children, it is associated with sudden death due to ventricular fibrillation resulting from a rapid response by the accessory pathway to atrial fibrillation, which itself seems to result from orthodromic reciprocating tachycardia. Historically, patients at risk for sudden death were characterised by the presence of symptoms and a shortest pre- excited R-R interval during induced atrial fibrillation <250 ms. Owing to the relatively high prevalence of asymptomatic Wolff-Parkinson-White pattern and availability of catheter ablation, there has been a need to identify risk among asymptomatic patients. Recent guidelines recommend invasive evaluation for such patients where pre-excitation clearly does not disappear during exercise testing. This strategy has a high negative predictive value only. The accuracy of this approach is under continued investigation, especially in light of other considerations: Patients having intermittent pre-excitation, once thought to be at minimal risk may not be, and the role of isoproterenol in risk assessment.
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Heidbüchel H, Panhuyzen-Goedkoop N, Corrado D, Hoffmann E, Biffi A, Delise P, Blomstrom-Lundqvist C, Vanhees L, Ivarhoff P, Dorwarth U, Pelliccia A. Recommendations for participation in leisure-time physical activity and competitive sports in patients with arrhythmias and potentially arrhythmogenic conditions Part I: Supraventricular arrhythmias and pacemakers. ACTA ACUST UNITED AC 2016; 13:475-84. [PMID: 16874135 DOI: 10.1097/01.hjr.0000216543.54066.72] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This document by the Study Group on Sports Cardiology of the European Society of Cardiology extends on previous recommendations for sports participation for competitive athletes by also incorporating guidelines for those who want to perform recreational physical activity. For different supraventricular arrhythmias and arrhythmogenic conditions, a description of the relationship between the condition and physical activity is given, stressing how arrhythmias can be influenced by exertion or can be a reflection of the (patho)physiological cardiac adaptation to sports participation itself. The following topics are covered in this text: sinus bradycardia; atrioventricular nodal conduction disturbances; pacemakers; atrial premature beats; paroxysmal supraventricular tachycardia without pre-excitation; pre-excitation, asymptomatic or with associated arrhythmias (i.e. Wolff-Parkinson-White syndrome); atrial fibrillation; and atrial flutter. A related document discusses ventricular arrhythmias, channelopathies and implantable cardioverter defibrillators.
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Affiliation(s)
- Hein Heidbüchel
- Department of Cardiology-Electrophysiology, University Hospital Gasthuisberg, Leuven, Belgium.
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Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes NM, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia. Circulation 2016; 133:e506-74. [DOI: 10.1161/cir.0000000000000311] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | | | | | - Hugh Calkins
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Jamie B. Conti
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Barbara J. Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - N.A. Mark Estes
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Michael E. Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Zachary D. Goldberger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Stephen C. Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Julia H. Indik
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Bruce D. Lindsay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Brian Olshansky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Andrea M. Russo
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Win-Kuang Shen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Cynthia M. Tracy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information. HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
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Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes NM, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: Executive Summary. Circulation 2016; 133:e471-505. [DOI: 10.1161/cir.0000000000000310] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | | | | | - Hugh Calkins
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Jamie B. Conti
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Barbara J. Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - N.A. Mark Estes
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Michael E. Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Zachary D. Goldberger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Stephen C. Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Julia H. Indik
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Bruce D. Lindsay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Brian Olshansky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Andrea M. Russo
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Win-Kuang Shen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
| | - Cynthia M. Tracy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see Appendix 1 for recusal information.HRS Representative. ACC/AHA Representative. ACC/AHA Task Force on Performance Measures Liaison. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. Former Task Force member; current member during this writing effort
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2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: Executive Summary. J Am Coll Cardiol 2016; 67:1575-1623. [DOI: 10.1016/j.jacc.2015.09.019] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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19
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Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes III NM, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia. Heart Rhythm 2016; 13:e136-221. [DOI: 10.1016/j.hrthm.2015.09.019] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Indexed: 01/27/2023]
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20
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Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes NAM, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm 2015; 13:e92-135. [PMID: 26409097 DOI: 10.1016/j.hrthm.2015.09.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Indexed: 10/23/2022]
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21
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Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, Estes NAM, Field ME, Goldberger ZD, Hammill SC, Indik JH, Lindsay BD, Olshansky B, Russo AM, Shen WK, Tracy CM, Al-Khatib SM. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2015; 67:e27-e115. [PMID: 26409259 DOI: 10.1016/j.jacc.2015.08.856] [Citation(s) in RCA: 239] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Ergul Y, Ozturk E, Ozyilmaz I, Unsal S, Carus H, Tola HT, Tanidir IC, Guzeltas A. Utility of Exercise Testing and Adenosine Response for Risk Assessment in Children with Wolff-Parkinson-White Syndrome. CONGENIT HEART DIS 2015; 10:542-51. [DOI: 10.1111/chd.12270] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Yakup Ergul
- Department of Pediatric Cardiology; İstanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Erkut Ozturk
- Department of Pediatric Cardiology; İstanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Isa Ozyilmaz
- Department of Pediatric Cardiology; İstanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Serkan Unsal
- Department of Anesthesiology; İstanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Hayat Carus
- Department of Anesthesiology; İstanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Hasan Tahsin Tola
- Department of Pediatric Cardiology; İstanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Ibrahim Cansaran Tanidir
- Department of Pediatric Cardiology; İstanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
| | - Alper Guzeltas
- Department of Pediatric Cardiology; İstanbul Mehmet Akif Ersoy, Thoracic and Cardiovascular Surgery Center and Research Hospital; Istanbul Turkey
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Sreeram N, Menzel C, Udink ten Cate FEA. Controversies in arrhythmias and arrhythmic syndromes of active children and young adults. Expert Rev Cardiovasc Ther 2015; 13:183-92. [DOI: 10.1586/14779072.2015.1000308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Abstract
The presence of a Wolf-Parkinson-White (WPW) pattern is not uncommonly discovered on a life insurance applicant's ECG. How does one determine the appropriate mortality risk in this population? This article will discuss the risk of sudden cardiac death (SCD), the interpretation of electrophysiology testing results, and risk-stratification both for asymptomatic individuals and those who have had ablation treatment.
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Dalili M, Vahidshahi K, Aarabi-Moghaddam MY, Rao JY, Brugada P. Exercise testing in children with Wolff-Parkinson-White syndrome: what is its value? Pediatr Cardiol 2014; 35:1142-6. [PMID: 24728424 DOI: 10.1007/s00246-014-0907-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 03/25/2014] [Indexed: 11/26/2022]
Abstract
This study was conducted to evaluate the accuracy of exercise testing for predicting accessory pathway characteristics in children with Wolff-Parkinson-White (WPW) syndrome. The study enrolled 37 children with WPW syndrome and candidates for invasive electrophysiologic study (EPS). Exercise testing was performed for all the study participants before the invasive study. Data from the invasive EPS were compared with findings from the exercise testing. The sudden disappearance of the delta (Δ) wave was seen in 10 cases (27 %). No significant correlation was found between the Δ wave disappearance and the antegrade effective refractory period of the accessory pathway (AERP-AP) or the shortest pre-excited RR interval (SPERRI). The sensitivity, specificity, and positive and negative predictive values of Δ wave disappearance, based on AERP-AP as gold standard, were respectively 29.4, 80, 71.4, and 40 %. The corresponding values with SPERRI as the gold standard were respectively 23.8, 71.4, 71.4 and 23.8 %. Exercise testing has a medium to low rate of accuracy in detecting low-risk WPW syndrome patients in the pediatric age group.
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Affiliation(s)
- M Dalili
- Rajaie Cardiovascular Medical and Research Center, Tehran, Islamic Republic of Iran,
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26
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Kubuš P, Vít P, Gebauer RA, Materna O, Janoušek J. Electrophysiologic Profile and Results of Invasive Risk Stratification in Asymptomatic Children and Adolescents With the Wolff–Parkinson–White Electrocardiographic Pattern. Circ Arrhythm Electrophysiol 2014; 7:218-23. [DOI: 10.1161/circep.113.000930] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Data on the results and clinical effect of an invasive risk stratification strategy in asymptomatic young patients with the Wolff–Parkinson–White electrocardiographic pattern are scarce.
Methods and Results—
Eighty-five consecutive patients aged <18 years with a Wolff–Parkinson–White pattern and persistent preexcitation at maximum exercise undergoing invasive risk stratification were retrospectively studied. Adverse accessory pathway (AP) properties were defined according to currently consented criteria as any of the following: shortest preexcited RR interval during atrial fibrillation/rapid atrial pacing ≤250 ms (or antegrade effective refractory period ≤250 ms if shortest preexcited RR interval was not available) or inducible atrioventricular re-entrant tachycardia. Age at evaluation was median 14.9 years. Eighty-two patients had a structurally normal heart and 3 had hypertrophic cardiomyopathy. A single manifest AP was present in 80, 1 manifest and 1 concealed AP in 4, and 2 manifest APs in 1 patient. Adverse AP properties were present in 32 of 85 patients (37.6%) at baseline and in additional 16 of 44 (36.4%) after isoproterenol. Ablation was performed in 41 of these 48 patients. Ablation was deferred in the remaining 7 for pathway proximity to the atrioventricular node. In addition, 18 of the low-risk patients were ablated based on patient/parental decision.
Conclusions—
Adverse AP properties at baseline were exhibited by 37.6% of the evaluated patients with an asymptomatic Wolff–Parkinson–White preexcitation persisting at peak exercise. Isoproterenol challenge yielded additional 36.4% of those tested at higher risk. Ablation was performed in a total of 69.4% of patients subjected to invasive risk stratification.
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Affiliation(s)
- Peter Kubuš
- From the Children’s Heart Center, University Hospital, Motol, Prague (P.K., O.M., J.J.); Pediatric Cardiology, Children’s University Hospital Brno, Brno, Czech Republic (P.V.); Department of Pediatric Cardiology, University of Leipzig, Heart Center, Leipzig, Germany (R.A.G.)
| | - Pavel Vít
- From the Children’s Heart Center, University Hospital, Motol, Prague (P.K., O.M., J.J.); Pediatric Cardiology, Children’s University Hospital Brno, Brno, Czech Republic (P.V.); Department of Pediatric Cardiology, University of Leipzig, Heart Center, Leipzig, Germany (R.A.G.)
| | - Roman A. Gebauer
- From the Children’s Heart Center, University Hospital, Motol, Prague (P.K., O.M., J.J.); Pediatric Cardiology, Children’s University Hospital Brno, Brno, Czech Republic (P.V.); Department of Pediatric Cardiology, University of Leipzig, Heart Center, Leipzig, Germany (R.A.G.)
| | - Ondřej Materna
- From the Children’s Heart Center, University Hospital, Motol, Prague (P.K., O.M., J.J.); Pediatric Cardiology, Children’s University Hospital Brno, Brno, Czech Republic (P.V.); Department of Pediatric Cardiology, University of Leipzig, Heart Center, Leipzig, Germany (R.A.G.)
| | - Jan Janoušek
- From the Children’s Heart Center, University Hospital, Motol, Prague (P.K., O.M., J.J.); Pediatric Cardiology, Children’s University Hospital Brno, Brno, Czech Republic (P.V.); Department of Pediatric Cardiology, University of Leipzig, Heart Center, Leipzig, Germany (R.A.G.)
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Suzuki T, Nakamura Y, Yoshida S, Yoshida Y, Shintaku H. Differentiating fasciculoventricular pathway from Wolff-Parkinson-White syndrome by electrocardiography. Heart Rhythm 2013; 11:686-90. [PMID: 24252285 DOI: 10.1016/j.hrthm.2013.11.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND In school-based cardiovascular screening programs in Japan, Wolff-Parkinson-White (WPW) syndrome is diagnosed based on the presence of an electrocardiographic (ECG) delta wave without differentiation from the fasciculoventricular pathway (FVP), although the risk of sudden death is associated only with the former. OBJECTIVE The purpose of this study was to differentiate FVP patients among children diagnosed with WPW syndrome by ECG. METHODS Children who were diagnosed with WPW syndrome through school screening between April 2006 and March 2008 and had QRS width ≤120 ms were included. Patients with asthma and/or coronary heart disease were excluded. FVP and WPW syndrome were differentiated based on ECG responses to adenosine triphosphate (ATP) injection. Age, PR interval, QRS width, and Rosenbaum classification were compared among patients. RESULTS Thirty patients (median age 12.7 years, range 6.5-15.7 years) participated in the study. FVP was diagnosed in 23 patients (76.7%), and WPW syndrome in 7 (23.3%). In Rosenbaum type A patients, all six patients had WPW syndrome, whereas FVP was diagnosed in 23 of 24 and WPW syndrome was diagnosed in 1 of 24 of type B patients. Age, PR interval, and QRS width were not significantly different between the two conditions. CONCLUSION ATP stress test was reliable in differentiating FVP from WPW syndrome. Although FVP is considered rare, the results of our study indicate that many WPW syndrome patients with QRS width ≤120 ms may actually have FVP. Patients categorized as type B are more likely to have FVP, whereas type A patients are most likely to have WPW syndrome.
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Affiliation(s)
- Tsugutoshi Suzuki
- Department of Pediatric Electrophysiology, Pediatric Medical Care Center, Osaka City General Hospital, Osaka, Japan.
| | - Yoshihide Nakamura
- Department of Pediatric Electrophysiology, Pediatric Medical Care Center, Osaka City General Hospital, Osaka, Japan
| | - Shuichiro Yoshida
- Department of Pediatric Electrophysiology, Pediatric Medical Care Center, Osaka City General Hospital, Osaka, Japan
| | - Yoko Yoshida
- Department of Pediatric Electrophysiology, Pediatric Medical Care Center, Osaka City General Hospital, Osaka, Japan
| | - Haruo Shintaku
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan
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Leong KMW, Kelland NF. Pre-excitation on the electrocardiogram: what next? Br J Hosp Med (Lond) 2013; 74:636-40. [PMID: 24220526 DOI: 10.12968/hmed.2013.74.11.636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kevin M W Leong
- Specialty Registrar in Cardiology, in the Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield
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OBEYESEKERE MANOJN, KLEIN GEORGEJ. Intermittent Preexcitation and the Risk of Sudden Death: The Exception That Proves the Rule? J Cardiovasc Electrophysiol 2012; 24:367-9. [DOI: 10.1111/j.1540-8167.2012.02425.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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30
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Cohen MI, Triedman JK, Cannon BC, Davis AM, Drago F, Janousek J, Klein GJ, Law IH, Morady FJ, Paul T, Perry JC, Sanatani S, Tanel RE. PACES/HRS expert consensus statement on the management of the asymptomatic young patient with a Wolff-Parkinson-White (WPW, ventricular preexcitation) electrocardiographic pattern: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology Foundation (ACCF), the American Heart Association (AHA), the American Academy of Pediatrics (AAP), and the Canadian Heart Rhythm Society (CHRS). Heart Rhythm 2012; 9:1006-24. [PMID: 22579340 DOI: 10.1016/j.hrthm.2012.03.050] [Citation(s) in RCA: 218] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Indexed: 10/28/2022]
Affiliation(s)
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- Arizona Pediatric Cardiology Consultants & Phoenix Children's Hospital, Phoenix, AZ, USA
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Spar DS, Silver ES, Hordof AJ, Liberman L. Relation of the utility of exercise testing for risk assessment in pediatric patients with ventricular preexcitation to pathway location. Am J Cardiol 2012; 109:1011-4. [PMID: 22221954 DOI: 10.1016/j.amjcard.2011.11.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 11/11/2011] [Accepted: 11/11/2011] [Indexed: 10/14/2022]
Abstract
The gradual loss of ventricular preexcitation during exercise stress testing (EST) has an unclear risk of an association with life-threatening arrhythmia and could be related to the accessory pathway (AP) location. We compared the loss of preexcitation during EST with the risk assessment during invasive electrophysiology testing and determined whether the loss of preexcitation correlates with the AP location. We retrospectively reviewed patients aged ≤21 years with ventricular preexcitation who had undergone both EST and an electrophysiology study. The patients were divided into 3 groups: sudden loss (SL), gradual loss (GL), or no loss (NL) of preexcitation during EST. A total of 76 patients were included, with 11 (14%) in the SL group, 18 (24%) in the GL group, and 47 (62%) in the NL group. The SL group demonstrated a longer cycle length with 1-to-1 conduction by way of the AP during incremental atrial pacing compared with the NL group (375 ± 135 ms vs 296 ± 52 ms, p = 0.002), with no difference between the GL and NL groups (325 ± 96 vs 296 ± 52 ms, p = NS). Of the patients with 1-to-1 AP conduction of <270 ms, none (0 of 11) were in the SL group compared to 18 of 47 in the NL group (p = 0.0017), with no significant difference in the GL group (5 of 18) compared to the NL group (p = NS). The patients in the GL group were more likely to have a left-sided AP (14 of 18) than the NL group (17 of 47, p = 0.002) and the SL group (3 of 11, p = 0.002). In conclusion, a sudden loss of preexcitation during an EST predicted a long cycle length with 1-to-1 conduction by way of the AP. Also, the AP conduction characteristics in patients with GL compared to those with NL did not differ, and the GL of preexcitation was more frequently seen in patients with a left-sided AP.
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CZOSEK RICHARDJ, ANDERSON JEFFREYB, MARINO BRADLEYS, MELLION KATELYN, KNILANS TIMOTHYK. Noninvasive Risk Stratification Techniques in Pediatric Patients with Ventricular Preexcitation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:555-62. [DOI: 10.1111/j.1540-8159.2010.03011.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cantu F, Goette A. Sudden cardiac death stratification in asymptomatic ventricular preexcitation. Europace 2009; 11:1536-7. [DOI: 10.1093/europace/eup340] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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35
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Balaji S. Asymptomatic Wolff-Parkinson-White Syndrome in Children. J Am Coll Cardiol 2009; 53:281-3. [DOI: 10.1016/j.jacc.2008.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 10/14/2008] [Indexed: 11/24/2022]
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Fazio G, Mossuto C, Basile I, Gennaro F, DʼAngelo L, Visconti C, Ferrara F, Novo G, Pipitone S, Novo S. Asymptomatic ventricular pre-excitation in children. J Cardiovasc Med (Hagerstown) 2009; 10:59-63. [DOI: 10.2459/jcm.0b013e32831a98c2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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38
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Sarubbi B. The Wolff–Parkinson–White electrocardiogram pattern in athletes: how and when to evaluate the risk for dangerous arrhythmias. The opinion of the paediatric cardiologist. J Cardiovasc Med (Hagerstown) 2006; 7:271-8. [PMID: 16645401 DOI: 10.2459/01.jcm.0000219320.97256.4d] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Although diagnostic assessment and treatment have been described in detail in patients with symptomatic Wolff-Parkinson-White (WPW) syndrome, the management of asymptomatic subjects remains controversial. Usually they are assumed to have a benign prognosis, although they do very occasionally present with ventricular fibrillation (VF) as the first manifestation of the syndrome. Discovering a WPW pattern in a previously asymptomatic athlete on a routine electrocardiogram (ECG) identifies the necessity for more accurate screening tests. However, non-invasive methods (Holter monitoring, exercise treadmill testing) seem to be relatively incomplete for risk stratification, especially for athletes. Current guidelines do not always recommend a routine electrophysiological study (EPS) in patients with an asymptomatic WPW ECG pattern, especially in children younger than 12 years. Individuals who engage in high-risk occupations or those patients who have a pre-excitation pattern which precludes them from following their chosen career or activities may be exceptions. The presence of inducible reciprocating tachycardia during EPS, especially when it triggers atrial fibrillation with short RR interval, can represent a specific risk marker of dangerous arrhythmias.
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Affiliation(s)
- Berardo Sarubbi
- Second University of Naples, Division of Cardiology, Monaldi Hospital, Naples, Italy.
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Wellens HJ. When to Perform Catheter Ablation in Asymptomatic Patients With a Wolff-Parkinson-White Electrocardiogram. Circulation 2005; 112:2201-7; discussion 2216. [PMID: 16203931 DOI: 10.1161/circulationaha.104.483321] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hein J Wellens
- Cardiovascular Research Institute Maastricht, 21 Henric van Veldekeplein, 6211 TG Maastricht, The Netherlands.
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40
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41
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Attari M, Dhala A. Role of invasive and noninvasive testing in risk stratification of sudden cardiac death in children and young adults: an electrophysiologic perspective. Pediatr Clin North Am 2004; 51:1355-78. [PMID: 15331288 DOI: 10.1016/j.pcl.2004.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Sudden cardiac death is a rare, but devastating, event in the young population. Arrhythmia is the mechanism of death in many cases. In addition to clinical history, noninvasive and invasive tests can be used to identify patients who are at risk. Although these tools are not perfect, they can prove valuable if used in proper clinical circumstances. An overview of these tests is presented.
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Affiliation(s)
- Mehran Attari
- Electrophysiology Laboratories, Cardiovascular Disease Section, St. Luke's and Aurora Sinai Medical Centers, University of Wisconsin Medical School-Milwaukee Clinical Campus, 2801 West Kinnickinnic River Parkway, Milwaukee, WI 53215, USA
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42
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Silverman GA, Whisstock JC, Askew DJ, Pak SC, Luke CJ, Cataltepe S, Irving JA, Bird PI. Human clade B serpins (ov-serpins) belong to a cohort of evolutionarily dispersed intracellular proteinase inhibitor clades that protect cells from promiscuous proteolysis. Cell Mol Life Sci 2004; 61:301-25. [PMID: 14770295 PMCID: PMC11138797 DOI: 10.1007/s00018-003-3240-3] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Serpins are unique among the various types of active site proteinase inhibitors because they covalently trap their targets by undergoing an irreversible conformational rearrangement. Members of the serpin superfamily are present in the three major domains of life (Bacteria, Archaea and Eukarya) as well as several eukaryotic viruses. The human genome encodes for at least 35 members that segregate evolutionarily into nine (A-I) distinct clades. Most of the human serpins are secreted and circulate in the bloodstream where they reside at critical checkpoints intersecting self-perpetuating proteolytic cascades such as those of the clotting, thrombolytic and complement systems. Unlike these circulating serpins, the clade B serpins (ov-serpins) lack signal peptides and reside primarily within cells. Most of the human clade B serpins inhibit serine and/or papain-like cysteine proteinases and protect cells from exogenous and endogenous proteinase-mediated injury. Moreover, as sequencing projects expand to the genomes of other species, it has become apparent that intracellular serpins belonging to distinct phylogenic clades are also present in the three major domains of life. As some of these serpins also guard cells against the deleterious effects of promiscuous proteolytic activity, we propose that this cytoprotective function, along with similarities in structure are common features of a cohort of intracellular serpin clades from a wide variety of species.
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Affiliation(s)
- G A Silverman
- Division of Newborn Medicine, Children's Hospital, Dept of Pediatrics, Harvard Medical School, 300 Longwood Ave, Enders 970, Boston, Massachusetts 02115, USA.
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Almendral Garrote J, González Torrecilla E, Atienza Fernández F, Vigil Escribano D, Arenal Maiz Á. Tratamiento de los pacientes con preexcitación ventricular. Rev Esp Cardiol 2004. [DOI: 10.1016/s0300-8932(04)77206-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Todd DM, Klein GJ, Krahn AD, Skanes AC, Yee R. Asymptomatic Wolff-Parkinson-White syndrome: is it time to revisit guidelines? J Am Coll Cardiol 2003; 41:245-8. [PMID: 12535817 DOI: 10.1016/s0735-1097(02)02707-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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LeLorier P, Klein GJ, Krahn A, Yee R, Skanes A. Should patients with asymptomatic wolff-parkinson-white pattern undergo a catheter ablation? Curr Cardiol Rep 2001; 3:301-4. [PMID: 11406088 DOI: 10.1007/s11886-001-0084-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Many individuals with the Wolff-Parkinson-White electrocardiographic pattern are asymptomatic. Optimal management of these individuals is still a matter of debate. On the one hand, sudden cardiac death from ventricular fibrillation is a rare yet possible outcome in these individuals. On the other hand, there is a low risk of serious complication from electrophysiologic study and ablation. Given that the risk of these competing strategies is comparable, the decision needs to be individualized with considerable patient input.
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Affiliation(s)
- P LeLorier
- Arrhythmia Service, London Health Sciences Center, University Campus, 339 Windermere Road, London, Ontario N6A 5A5, Canada.
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46
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Abstract
Propafenone is a sodium channel blocking antiarrhythmic drug. It also has beta-adrenergic, potassium channel, and weak calcium channel blocking activity. The drug is metabolized in the liver with rates dependent on the debrisoquin phenotype. The saturable metabolism results in nonlinear pharmacokinetics. The metabolites retain sodium channel blocking activity but little beta-adrenergic blocking activity. Both controlled and noncontrolled studies have documented its efficacy in a variety of supraventricular arrhythmias. Intravenous propafenone is effective in converting atrial fibrillation to normal sinus rhythm. Chronic oral administration decreases the frequency of recurrence of atrial fibrillation and paroxysmal supraventricular tachycardia. The drug is particularly effective in the Wolff-Parkinson-White syndrome. The drug may produce SA block in patients with underlying sinus node dysfunction. Propafenone has comparatively few noncardiac side effects. It is a useful primary drug or an alternative to more commonly used drugs used for the treatment of supraventricular arrhythmias.
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Affiliation(s)
- A O Grant
- Cardiovascular Division, Duke University Medical Center, Durham, North Carolina 27706, USA
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47
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Zardini M, Yee R, Thakur RK, Klein GJ. Risk of sudden arrhythmic death in the Wolff-Parkinson-White syndrome: current perspectives. Pacing Clin Electrophysiol 1994; 17:966-75. [PMID: 7517532 DOI: 10.1111/j.1540-8159.1994.tb01440.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- M Zardini
- Department of Medicine, University of Western Ontario, London, Canada
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48
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Auricchio A. Reversible protective effect of propafenone or flecainide during atrial fibrillation in patients with an accessory atrioventricular connection. Am Heart J 1992; 124:932-7. [PMID: 1529904 DOI: 10.1016/0002-8703(92)90975-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In 34 patients with a symptomatic accessory atrioventricular connection the reversible protective effect of orally administered flecainide (300 mg/day) and of propafenone (900 mg/day) in control of ventricular response during atrial fibrillation by exercise was assessed. The study consisted of three sections of 1 week each: an initial treatment phase during which propafenone or flecainide was administered, a drug-free phase, and a period of crossover to treatment with the other drug. At the end of each phase, transesophageal stimulation was performed during physical exercise to induce atrial fibrillation episodes: the goal was to control the persistence of drug effectiveness. At rest, the mean and shortest R-R interval during the period of induced atrial fibrillation in patients who were treated with flecainide or propafenone increased significantly as compared with the drug-free period. On the other hand, at maximum exercise levels no difference in both shortest and mean R-R intervals during atrial fibrillation was observed between patients who were treated with flecainide and those who were treated with propafenone, as well as between flecainide treatment and the drug-free period, whereas a slightly significant difference persisted with propafenone treatment (p less than 0.05). In addition, at maximum exercise levels no significant difference in the number of preexcited QRS complexes among the three treatments was noted. The data from this study suggests that a reversible protective effect against rapid ventricular rate as the result of an episode of atrial fibrillation exists during exercise in patients with a symptomatic accessory atrioventricular connection who are treated with flecainide or propafenone.
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Affiliation(s)
- A Auricchio
- Department of Cardiac Surgery, University of Rome, Tor Vergata, European Hospital, Italy
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Drago F, Turchetta A, Calzolari A, Guccione P, Santilli A, Pompei E, Ragonese P, Galioto FM. Detection of atrial tachyarrhythmias by transesophageal pacing and recording at rest and during exercise in children with ventricular preexcitation. Am J Cardiol 1992; 69:1098-9. [PMID: 1561989 DOI: 10.1016/0002-9149(92)90874-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- F Drago
- Dipartimento Medico Chirurgico di Cardiologia Pediatrica, Ospedale Pediatrico Bambino Gesu', Rome, Italy
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Wang YS, Scheinman MM, Chien WW, Cohen TJ, Lesh MD, Griffin JC. Patients with supraventricular tachycardia presenting with aborted sudden death: incidence, mechanism and long-term follow-up. J Am Coll Cardiol 1991; 18:1711-9. [PMID: 1960318 DOI: 10.1016/0735-1097(91)90508-7] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A total of 13 (4.5%) of 290 patients with aborted sudden death had either documented (7; 54%) or strong presumptive evidence of supraventricular tachycardia that deteriorated into ventricular fibrillation. Six (46%) of the 13 had an accessory conduction pathway and either atrial fibrillation (5 patients) or paroxysmal atrioventricular (AV) reentrant tachycardia (1 patient) that deteriorated into ventricular fibrillation. Three patients with AV node reentrant tachycardia and four with atrial fibrillation and enhanced AV node conduction presented with supraventricular arrhythmias that deteriorated into ventricular fibrillation. Patients were treated with medical, surgical or catheter ablative procedures designed to prevent recurrences of supraventricular arrhythmias. Four patients received an implanted automatic defibrillator, but none had an appropriate device discharge. Over a follow-up period of 41.6 +/- 33.6 months, 12 patients are alive without symptomatic arrhythmias. One patient died because of severe chronic lung disease and heart failure. Supraventricular tachycardia was the cause of aborted sudden death in approximately 5% of patients referred for evaluation of sudden cardiac death. Treatment directed at prevention of supraventricular tachycardia was associated with an excellent prognosis. Current treatment techniques appear to obviate the need for automatic defibrillator therapy in these patients.
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Affiliation(s)
- Y S Wang
- Department of Medicine, University of California, San Francisco
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