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Mahmud R, Sanchez-Quintana D, Macias Y, de Almeida MC, Anderson RH, Back Sternick E. Correction of bundle branch block by so-called nonselective His bundle pacing: The potential role of accessory connections in the ventricular septal crest. Heart Rhythm 2024; 21:647-654. [PMID: 38215806 DOI: 10.1016/j.hrthm.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024]
Affiliation(s)
- Rehan Mahmud
- Cardiac Electrophysiology Department, McLaren Bay Region, Bay City, Michigan
| | - Damian Sanchez-Quintana
- Department of Human Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, Badajoz, Spain
| | - Yolanda Macias
- Department of Medical and Surgical Therapeutics, Faculty of Veterinary, University of Extremadura, Cáceres, Spain
| | - Marcos Célio de Almeida
- Department of Genetics and Morphology, University of Brasilia, Campus Asa Norte, Brasilia, Brazil
| | - Robert H Anderson
- Biosciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Eduardo Back Sternick
- Arrhythmia and Electrophysiology Department, Biocor Hospital, Rede D'Or São Luiz, Nova Lima, Brazil.
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2
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Bera D, Mukherjee SS, Halder A, Choudhury SK. Absent ventriculo-atrial conduction during right ventricular apical pacing but nodal response during para-Hisian pacing - What is the mechanism? Indian Pacing Electrophysiol J 2024; 24:45-48. [PMID: 38128877 PMCID: PMC10928006 DOI: 10.1016/j.ipej.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/10/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
A 13-year-old-girl presented with one episode of pre-syncope while standing in a train. Her ECG was suggestive of preexcitation. Echocardiography revealed structurally normal heart without any ventricular hypertrophy. During electrophysiology study, her ventriculo-atrial (VA) conduction was absent even on isoprenaline. However, a para-Hisian pacing maneuver (PHP) revealed consistent VA conduction with a nodal response. This finding indicated that the VA dissociation at baseline was at infra-Hisian (VH) level and conduction at HA level was intact. In addition, this finding is coherent with a speculation of a fasciculo-ventricular pathway (FVP) resulting in such an ECG pattern in her. Pacing from various atrial sites (right atrium, coronary sinus) exhibited nearly fixed preexcitation and short non-varying HV interval confirmatory of FVP. Testing for a PRKAG mutation was advised for her.
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Affiliation(s)
| | | | - Ashesh Halder
- DM, Dept of Cardiology, Medica Superspeciality Hospital, Kolkata, India
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Unusual QRS complexes associated with the simultaneous presence of a right-sided accessory pathway, fasciculoventricular pathway, and incomplete right bundle branch block. J Cardiol Cases 2023; 27:101-104. [PMID: 36910041 PMCID: PMC9995657 DOI: 10.1016/j.jccase.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/01/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
Abstract
A 52-year-old man presented with delta waves on a body surface electrocardiogram, which suggested the presence of a right-sided accessory pathway (AP). Patients with right-sided APs generally have an rS pattern in leads V1-2, while he had an rS in lead V1 but an Rs in lead V2, which could not rule out the possibility of the presence of a septal AP or fasciculoventricular pathway (FVP). On the other hand, patients with septal APs or FVPs generally have a QS pattern in lead V1 instead of an rS pattern. An electrophysiological study demonstrated that the simultaneous presence of a right-sided posterolateral AP and FVP with incomplete right bundle branch block (ICRBBB) generated those unusual QRS complexes. The FVP arose distal to the site with ICRBBB, and the ICRBBB delayed the initiation of the FVP conduction. The delayed QS and Rs waves in leads V1-2 generated by the FVP conduction with ICRBBB appeared to produce rS and Rs patterns in leads V1-2, respectively. A radiofrequency application along the posterolateral tricuspid annulus eliminated the right-sided AP conduction. If the localization of APs based on the QRS morphology is difficult, multiple APs or an FVP with a conduction system disturbance should be noted. Learning objective Patients with right-sided posterolateral accessory pathways (APs) generally have an rS pattern in lead V2, while patients with fasciculoventricular pathways (FVPs) generally have a QS pattern in lead V1. The present case with a suspected right-sided posterolateral AP had unusual QRS complexes, an rS in lead V1, Rs in lead V2, and monophasic R in leads V3-6, which were associated with the simultaneous presence of a right-sided posterolateral AP, FVP, and incomplete right bundle branch block.
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4
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Sulu A, Kafali HC, Sahin GT, Ergul Y. Electrocardiographic and electrophysiological characteristics of fasciculoventricular fibers in children. Pacing Clin Electrophysiol 2022; 45:1165-1171. [PMID: 35866690 DOI: 10.1111/pace.14568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/26/2022] [Accepted: 07/08/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Fasciculoventricular fiber (FVF) that does not cause tachyarrhythmia is a rare form of ventricular preexcitation, which is important to distinguish from Kent fibers. Although adenosine and some electrocardiographic features are important in the differentiation of Wolff Parkinson White (WPW) than FVF, a clear distinction may not always be possible without an electrophysiological study (EPS). In this study, we aimed to present the clinical and electrophysiological features of our pediatric patients with fasciculoventricular fiber. PATIENTS AND METHOD Between October 2013 and September 2021, 565 patients who underwent electrophysiological studies due to ventricular preexcitation in our clinic were screened in the study, and 27 (4.7%) patients with fasciculoventricular fiber were included. The data of the patients were obtained from the file records using the electronic internet database system Filemaker®. Electrophysiological study age, weight, gender, symptom, and presence of congenital heart disease of the patients were obtained from the file records. Accessory pathway localization was evaluated according to the modified Arruda algorithm in pre-procedural electrocardiography. In addition, delta wave amplitudes were measured in the first 40 ms from the surface ECG. PR interval, QRS interval, and delta wave amplitude were recorded before and after ablation in patients with additional accessory pathways. Post-procedure values were included in the FVF group. RESULTS The mean age of the patients was 11.47±4.25 years. 70.4% of the reasons for admission were symptoms such as palpitations and syncope. Two patients had hypertrophic cardiomyopathy and one patient had ccTGA. In the electrophysiological study, additional manifest WPW was found in 9 (33%) patients (3 patients with high risk, 6 patients with orthodromic supraventricular tachycardia), focal atrial tachycardia in a patient, and atrioventricular nodal reentry tachycardia in a patient. While the delta wave amplitude was found to be 2.56±1.38(1-5.5) mm in the first 40 ms in surface electrocardiography in 9 patients with additional accessory pathway, it was found to be 1.64±0.67(0.5-3) mm in the FVF group. There was no statistically significant difference between the two groups (p = 0.398). Delta wave amplitude >3.5mm was not detected in any patient with isolated FVF. Interestingly, delta wave amplitude was <3.5mm in 7 (78%) of 9 patients who were identified and ablated with an additional accessory pathway. 19 of the patients (59.3%) were adenosine-responsive (18 isolated FVF, 1 manifest AP+FVF adenosine-responsive. 8 patients with other manifest AP + FVF had no pre-procedural adenosine-asystole response, and all of them QRS were expanded). CONCLUSION Although the fasciculoventricular fibers themselves are not the cause of tachyarrhythmia, the accessory pathway and other tachyarrhythmia substrate frequency accompanying these cases are quite high (approximately 40%) in EPS. The delta wave characteristics of ablated patients are very similar to FVF patients. While all patients with isolated FVF were adenosine responsive, most of those with additional manifest WPW were unresponsive. Therefore, performing EPS in patients with suspected FVF based on surface ECG features seems to be important for the detection of additional tachyarrhythmias and risky accessory pathways. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ayse Sulu
- Department of Pediatric Cardiology, University of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey.,Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Hasan Candas Kafali
- Department of Pediatric Cardiology, University of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Gulhan Tunca Sahin
- Department of Pediatric Cardiology, University of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Yakup Ergul
- Department of Pediatric Cardiology, University of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
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Yang L, Chen Z, Zhang M. Case Report: An Unusual Case of Fasciculoventricular Pathway. Front Cardiovasc Med 2022; 9:818275. [PMID: 35252397 PMCID: PMC8896400 DOI: 10.3389/fcvm.2022.818275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/17/2022] [Indexed: 11/22/2022] Open
Abstract
A 30-year-old man with an ECG demonstrating ventricular preexcitation with a normal PR interval and a QR pattern in lead V1 was evaluated. Electrophysiology studies showed a normal AH interval and a shortened HV interval at sinus rhythm; while the degree of preexcitation (QRS waveform) and HV interval were not affected by multisite or incremental atrial pacing. These findings implied ventricular preexcitation due to a fasciculoventricular pathway (FVP). Moreover, temporarily blocking FVP conduction mechanically resulted in normal HV interval, absence of delta wave, and an rSR pattern in V1, which indicated incomplete right bundle branch block (IRBBB). These findings suggested the coexistence of FVP and IRBBB, which is very rare.
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Gormel S, Yasar S. Fasciculoventricular pathways-A rare and innocent variant: A Retrospective study focusing on clinical and electrophysiologic characteristics. Ann Noninvasive Electrocardiol 2022; 27:e12913. [PMID: 34974635 PMCID: PMC9107080 DOI: 10.1111/anec.12913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Fasciculoventricular pathways (FVPs) are variants of pre-excitation syndrome which were investigated insufficiently because of its rarity. OBJECTIVE This report aimed to represent one of the largest series of FVP, focusing on its clinical and electrophysiological properties. METHODS We analyzed retrospectively 26 consecutive patients who underwent electrophysiological study (EPS) for FVP between January 1998 and June 2020. RESULTS Among 1437 patients with accessory pathways, 26 had FVP (1.80%). All the 26 patients (100%) were males, with a mean age of 22.15 ± 3.50 years (range, 20-34 years). In the baseline electrocardiograms of the patients with FVP, pre-excitation and transitional zone were seen in leads V2 -V4 . During EPS procedures, normal AH interval and shortened HV interval were detected. All the patients had AH prolongation after atrial pacing due to atrioventricular (AV) nodal delay without change in pre-excitation degree. Five of the FVP patients (19.2%) had extra accessory pathways, all of which were ablated successfully while the FVPs were followed clinically. CONCLUSION Fasciculoventricular pathways are uncommon variants of pre-excitation syndrome; therefore, they should be diagnosed correctly and followed up noninvasively to avoid damages.
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Affiliation(s)
- Suat Gormel
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Salim Yasar
- Department of Cardiology, Gulhane Research and Training Hospital, Ankara, Turkey
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Gu W, Maimaitijiang A, Huang Q, Wu B, Sun S, Luo X, Li J, Xiong N. Pseudo normalization of H-V interval due to intra-His block in a patient with fasciculoventricular accessory pathway. J Electrocardiol 2020; 64:9-11. [PMID: 33260025 DOI: 10.1016/j.jelectrocard.2020.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/12/2020] [Accepted: 11/15/2020] [Indexed: 10/23/2022]
Abstract
A 57-year-old male suffering from cardiogenic syncope was found to have preexcited QRS on surface ECG at admission. A dual-chamber ICD was implanted after discovering intermittent high degree A-V block and ventricular tachycardia during hospitalization. An EP study was performed 2 days later. Fasciculoventricular accessory pathway was diagnosed based on the fixed H-V interval with different A-H interval when atrial activation conducted to ventricle. However, the H-V interval was normal, which can be explained by intra-His block based on the findings of two split His potentials, the second of which was closely followed by local ventricular electrogram. The conduction delay in His bundle led to pseudo normalization of H-V interval.
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Affiliation(s)
- Wentao Gu
- Department of Cardiology, Huashan Hospital Fudan University, 12 Wulumuqizhong Road, Shanghai 200040, China
| | - Alimujiang Maimaitijiang
- Department of Cardiology, Huashan Hospital Fudan University, 12 Wulumuqizhong Road, Shanghai 200040, China
| | - Qingyu Huang
- Department of Cardiology, Huashan Hospital Fudan University, 12 Wulumuqizhong Road, Shanghai 200040, China
| | - Bangwei Wu
- Department of Cardiology, Huashan Hospital Fudan University, 12 Wulumuqizhong Road, Shanghai 200040, China
| | - Shengjia Sun
- Department of Cardiology, Huashan Hospital Fudan University, 12 Wulumuqizhong Road, Shanghai 200040, China
| | - Xinping Luo
- Department of Cardiology, Huashan Hospital Fudan University, 12 Wulumuqizhong Road, Shanghai 200040, China
| | - Jian Li
- Department of Cardiology, Huashan Hospital Fudan University, 12 Wulumuqizhong Road, Shanghai 200040, China
| | - Nanqing Xiong
- Department of Cardiology, Huashan Hospital Fudan University, 12 Wulumuqizhong Road, Shanghai 200040, China.
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8
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Abstract
In some cases, atrioventricular reentrant arrhythmias are sustained by accessory pathways with peculiar electrophysiologic properties related to their specific anatomy. Most of these fibers, which may be responsible for variants of ventricular preexcitation, show decremental conduction properties due to a nodelike aspect or a peculiar tortuous anatomic route across the atrioventricular groove. Moreover, some fibers do not actively sustain any reentrant circuit and can be only involved as bystander in other arrhythmias. Although rare, these accessory pathway variants should be properly diagnosed using noninvasive and invasive methods to guide catheter ablation procedures when needed.
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9
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Nagashima K, Wakamatsu Y, Kurokawa S, Otsuka N, Yagyu S, Okumura Y. Minimally preexcited tachycardia: What is the mechanism? HeartRhythm Case Rep 2020; 6:805-807. [PMID: 33101961 PMCID: PMC7573369 DOI: 10.1016/j.hrcr.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Koichi Nagashima
- Address reprint requests and correspondence: Dr Koichi Nagashima, Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo 173-8610, Japan.
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10
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Asvestas D, Bazoukis G, Mililis P, Dragasis S, Megarisiotou A, Vlachos K, Sideris A, Efremidis M, Letsas KP. Fasciculoventricular bypass tracts: Electrocardiographic and electrophysiologic features. J Arrhythm 2020; 36:537-541. [PMID: 32528586 PMCID: PMC7279985 DOI: 10.1002/joa3.12355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/12/2020] [Accepted: 04/16/2020] [Indexed: 12/13/2022] Open
Abstract
Fasciculoventricular accessory pathways are rare variants of preexcitation. The differential diagnosis of fasciculoventricular accessory pathways from other preexcitation variants can be challenging. Based on two cases, we discuss the specific electrocardiographic and electrophysiologic features of fasciculoventricular bypass tracts.
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Affiliation(s)
- Dimitrios Asvestas
- Arrhythmia Unit Laboratory of Cardiac Electrophysiology "Evangelismos" General Hospital of Athens Athens Greece
| | - George Bazoukis
- Arrhythmia Unit Laboratory of Cardiac Electrophysiology "Evangelismos" General Hospital of Athens Athens Greece
| | - Panagiotis Mililis
- Arrhythmia Unit Laboratory of Cardiac Electrophysiology "Evangelismos" General Hospital of Athens Athens Greece
| | - Stelios Dragasis
- Arrhythmia Unit Laboratory of Cardiac Electrophysiology "Evangelismos" General Hospital of Athens Athens Greece
| | - Athanasia Megarisiotou
- Arrhythmia Unit Laboratory of Cardiac Electrophysiology "Evangelismos" General Hospital of Athens Athens Greece
| | - Konstantinos Vlachos
- Arrhythmia Unit Laboratory of Cardiac Electrophysiology "Evangelismos" General Hospital of Athens Athens Greece
| | - Antonios Sideris
- Arrhythmia Unit Laboratory of Cardiac Electrophysiology "Evangelismos" General Hospital of Athens Athens Greece
| | - Michael Efremidis
- Arrhythmia Unit Laboratory of Cardiac Electrophysiology "Evangelismos" General Hospital of Athens Athens Greece
| | - Konstantinos P Letsas
- Arrhythmia Unit Laboratory of Cardiac Electrophysiology "Evangelismos" General Hospital of Athens Athens Greece
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11
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Inagaki D, Moriyama Y, Fukamizu S, Sakurada H. Fasciculoventricular pathway connecting to the left posterior fascicle area throughout the slow pathway with longitudinal dissociation in the His bundle. J Cardiovasc Electrophysiol 2019; 31:259-262. [PMID: 31778251 DOI: 10.1111/jce.14301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Dai Inagaki
- Department of Cardiology, Tokyo Metropolitan Health and Medical Corporation Ohkubo Hospital, Tokyo, Japan.,Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Yuichi Moriyama
- Department of Cardiology, Tokyo Metropolitan Health and Medical Corporation Ohkubo Hospital, Tokyo, Japan
| | - Seiji Fukamizu
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Harumizu Sakurada
- Department of Cardiology, Tokyo Metropolitan Health and Medical Corporation Ohkubo Hospital, Tokyo, Japan
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12
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Soares Correa F, Lokhandwala Y, Sánchez-Quintana D, Mori S, Anderson RH, Wellens HJJ, Back Sternick E. Unusual variants of pre-excitation: From anatomy to ablation: Part III-Clinical presentation, electrophysiologic characteristics, when and how to ablate nodoventricular, nodofascicular, fasciculoventricular pathways, along with considerations of permanent junctional reciprocating tachycardia. J Cardiovasc Electrophysiol 2019; 30:3097-3115. [PMID: 31646696 DOI: 10.1111/jce.14247] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/24/2019] [Accepted: 10/12/2019] [Indexed: 11/30/2022]
Abstract
The recognition of the presence, location, and properties of unusual accessory pathways for atrioventricular conduction is an exciting, but frequently a difficult, challenge for the clinical cardiac arrhythmologist. In this third part of our series of reviews, we discuss the different steps required to come to the correct diagnosis and management decision in patients with nodofascicular, nodoventricular, and fasciculo-ventricular pathways. We also discuss the concealed accessory atrioventricular pathways with the properties of decremental retrograde conduction that are associated with the so-called permanent form of junctional reciprocating tachycardia. Careful analysis of the 12-lead electrocardiogram during sinus rhythm and tachycardias should always precede the investigation in the catheterization room. When using programmed electrical stimulation of the heart from different intracardiac locations, combined with activation mapping, it should be possible to localize both the proximal and distal ends of the accessory connections. This, in turn, should then permit the determination of their electrophysiologic properties, providing the answer to the question "are they incorporated in a tachycardia circuit?". It is this information that is essential for decision-making with regard to the need for catheter ablation, and if necessary, its appropriate site.
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Affiliation(s)
- Frederico Soares Correa
- Post Graduation Department, Faculdade de Ciências Médicas, Belo Horizonte, Brazil.,Arrhythmia and Electrophysiology Department, Biocor Institute, Nova Lima, Brazil
| | | | | | - Shumpei Mori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Hein J J Wellens
- CARIM-Cardiovascular Research Centre Maastricht, Maastricht, The Netherlands
| | - Eduardo Back Sternick
- Post Graduation Department, Faculdade de Ciências Médicas, Belo Horizonte, Brazil.,Arrhythmia and Electrophysiology Department, Biocor Institute, Nova Lima, Brazil
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13
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Kim YG, Nam GB, Cho MS, Park GM, Kim M, Lee JH, Hwang KW, Kim J, Choi KJ, Kim YH. Impact of fasciculoventricular bypass tracts on the diagnosis and treatment of concomitant arrhythmias and cardiac diseases. J Electrocardiol 2019; 55:34-40. [DOI: 10.1016/j.jelectrocard.2019.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/09/2019] [Accepted: 04/03/2019] [Indexed: 11/16/2022]
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14
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Differentiation of fasciculoventricular fibers from anteroseptal accessory pathways using the surface electrocardiogram. Heart Rhythm 2019; 16:1072-1079. [DOI: 10.1016/j.hrthm.2019.02.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Indexed: 11/18/2022]
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15
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Jones CI, Cherian T, Upadhyay GA, Tung R. Wide complex tachycardia transitioning between 2 morphologies: What is the mechanism? J Cardiovasc Electrophysiol 2018; 29:1327-1329. [DOI: 10.1111/jce.13650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/16/2018] [Accepted: 05/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Christopher I. Jones
- Center for Arrhythmia CareThe University of Chicago Medicine, Pritzker School of Medicine Chicago IL USA
| | - Tharian Cherian
- Center for Arrhythmia CareThe University of Chicago Medicine, Pritzker School of Medicine Chicago IL USA
| | - Gaurav A. Upadhyay
- Center for Arrhythmia CareThe University of Chicago Medicine, Pritzker School of Medicine Chicago IL USA
| | - Roderick Tung
- Center for Arrhythmia CareThe University of Chicago Medicine, Pritzker School of Medicine Chicago IL USA
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16
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Itoh T, Yamada T. Persistent ventricular preexcitation despite right bundle branch block. Indian Pacing Electrophysiol J 2018; 18:146-147. [PMID: 29407483 PMCID: PMC6090072 DOI: 10.1016/j.ipej.2018.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 01/25/2018] [Indexed: 11/30/2022] Open
Abstract
A 44-year-old man with a history of ventricular preexcitation and supraventricular tachycardia was evaluated. The baseline electrocardiogram exhibited ventricular preexcitation with a normal PR interval and a minimally negative delta wave in lead V1 and positive delta waves in the inferior leads. The administration of adenosine resulted in a progressive prolongation of the PR interval with a fixed preexcitation degree, suggesting the presence of antegrade conduction over the fasciculo-ventricular pathway. When complete right bundle branch block occurred, the degree of preexcitation never changed. These findings suggested that the fasciculo-ventricular pathway was likely to be connected to the left-sided His-Purkinje system.
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17
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de Alencar Neto JN, Ramalho de Moraes SR, Back Sternick E, Wellens HJJ. Atypical bypass tracts: can they be recognized during sinus rhythm? Europace 2018; 21:208-218. [DOI: 10.1093/europace/euy079] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/20/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- José Nunes de Alencar Neto
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Rua Napoleao de Barros, 715-Vila Clementino Sao Paulo, SP-CEP, São Paulo, Brazil
| | - Saulo Rodrigo Ramalho de Moraes
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Rua Napoleao de Barros, 715-Vila Clementino Sao Paulo, SP-CEP, São Paulo, Brazil
| | - Eduardo Back Sternick
- Faculdade Ciências Médicas, Belo Horizonte, Alameda Ezequiel Dias, 275 - Centro, Belo Horizonte - MG, Brazil
- Arrhythmia Unit, Biocor Hospital, Alameda Oscar Niemeyer, 217 - Vila da Serra, Nova Lima - MG, Brazil
| | - Hein J J Wellens
- Cardiovascular Research Institute, Cardiovascular Research Institute, 6229 HX Maastricht, The Netherlands
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Abstract
In humans, dominant mutations in the gene encoding the regulatory γ2-subunit of AMP-activated protein kinase (PRKAG2) result in a highly penetrant phenotype dominated by cardiac features: left ventricular hypertrophy, ventricular pre-excitation, atrial tachyarrhythmia, cardiac conduction disease, and myocardial glycogen storage. The discovery of a link between the cell's fundamental energy sensor, AMPK, and inherited cardiac disease catalyzed intense interest into the biological role of AMPK in the heart. In this chapter, we provide an introduction to the spectrum of human disease resulting from pathogenic variants in PRKAG2, outlining its discovery, clinical genetics, and current perspectives on its pathogenesis and highlighting mechanistic insights derived through the evaluation of disease models. We also present a clinical perspective on the major components of the cardiomyopathy associated with mutations in PRKAG2, together with less commonly described extracardiac features, its prognosis, and principles of management.
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Affiliation(s)
- Arash Yavari
- Experimental Therapeutics, Radcliffe Department of Medicine, University of Oxford, Oxford, UK. .,Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK. .,The Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK.
| | - Dhruv Sarma
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,The Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Eduardo B Sternick
- Instituto de Pós-Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
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Rohrhoff NJ, Finne HA, Rodriguez Y. A sailor's dilemma: A case of preexcitation via a fasciculoventricular pathway. HeartRhythm Case Rep 2017; 3:364-367. [PMID: 28748146 PMCID: PMC5511980 DOI: 10.1016/j.hrcr.2017.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Huckelberry A Finne
- Naval Special Warfare Group 2 Logistics and Support Unit, Virginia Beach, Virginia
| | - Yasser Rodriguez
- Department of Internal Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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[Electrocardiographic characteristics of fasciculo-ventricular accessory pathways in children: A comparative study with right anteroseptal accessory pathways]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2017; 88:212-218. [PMID: 28666599 DOI: 10.1016/j.acmx.2017.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/29/2017] [Accepted: 05/29/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Fasciculo-ventricular (FV) accessory pathways (AP's) and right anteroseptal (RAS) AP's share similar anatomic locations and electrocardiographic characteristics. The objective of this article is to compare these features in children. METHODS All patients with manifest pre-excitation who underwent an electrophysiological study were included. Fasciculo-ventricular AP's were defined by the presence of an HV interval≤32ms and a prolongation of the AH without changes in the HV interval, or the level of pre-excitation during atrial pacing. Three independent and blind observers analysed the ECG's in both groups. RESULTS Out of 288 patients, 15 (5.2%) had FV AP's and 14 (4.9%) right AS AP's. The PR interval was longer in FV AP's than in RAS (113±21 vs 86±13ms respectively; P<.001) and the QRS was narrower (95±12 vs 137±24ms respectively; P<.001). The ECG in patients with FV AP's showed a rapid low amplitude deflection at the begining of the QRS in 13 out of 15 patients (87%) and in 2 (14%) the RAS AP group (P=.003). CONCLUSIONS The PR interval was longer and the QRS complex was narrower in patients with FV AP's. The presence of a rapid low amplitude deflection at the beginning of the QRS complex would allow to differentiate them from RAS AP's non-invasively.
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ARIAS MIGUELA, PACHÓN MARTA, AKERSTRÖM FINN, JIMÉNEZ-LÓPEZ JESÚS. An Irregular Rhythm in a Patient with Ventricular Preexcitation: What Is The Mechanism? J Cardiovasc Electrophysiol 2014; 25:217-9. [DOI: 10.1111/jce.12272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 08/12/2013] [Accepted: 08/13/2013] [Indexed: 11/30/2022]
Affiliation(s)
- MIGUEL A. ARIAS
- Cardiac Arrhythmia and Electrophysiology Unit; Department of Cardiology; Hospital Virgen de la Salud; Toledo Spain
| | - MARTA PACHÓN
- Cardiac Arrhythmia and Electrophysiology Unit; Department of Cardiology; Hospital Virgen de la Salud; Toledo Spain
| | - FINN AKERSTRÖM
- Cardiac Arrhythmia and Electrophysiology Unit; Department of Cardiology; Hospital Virgen de la Salud; Toledo Spain
| | - JESÚS JIMÉNEZ-LÓPEZ
- Cardiac Arrhythmia and Electrophysiology Unit; Department of Cardiology; Hospital Virgen de la Salud; Toledo Spain
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Chaib A, Bouzelmat H, Boulaamayel S, Kheyi J, Moustaghfir A. [A blocked preexcitation]. Presse Med 2014; 43:480-2. [PMID: 24440767 DOI: 10.1016/j.lpm.2013.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 01/30/2013] [Accepted: 03/18/2013] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ali Chaib
- Hôpital militaire Mohammed V, service de soins intensifs et de rythmologie, Rabat, Maroc.
| | - Hicham Bouzelmat
- Hôpital militaire Mohammed V, service de soins intensifs et de rythmologie, Rabat, Maroc
| | - Sanae Boulaamayel
- Hôpital militaire Mohammed V, service de soins intensifs et de rythmologie, Rabat, Maroc
| | - Jamal Kheyi
- Hôpital militaire Mohammed V, service de soins intensifs et de rythmologie, Rabat, Maroc
| | - Abdelhamid Moustaghfir
- Hôpital militaire Mohammed V, service de soins intensifs et de rythmologie, Rabat, Maroc
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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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González-Torrecilla E, Peinado R, Almendral J, Arenal A, Atienza F, García Fernández J, Fernández-Avilés F. Reappraisal of classical electrocardiographic criteria in detecting accessory pathways with a strict para-Hisian location. Heart Rhythm 2012; 10:16-21. [PMID: 23079032 DOI: 10.1016/j.hrthm.2012.08.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Identification of electrocardiographic (ECG) criteria for para-Hisian accessory pathways (APs) is based on a small series of patients. The presence of a negative delta wave in leads V(1) and V(2) has been suggested as an ECG marker of this AP location. OBJECTIVE To validate these ECG findings in a large series of patients with strict invasive criteria for that location. METHODS We included 105 patients (39 women, 66 men; mean age 26 ± 12 years, range 5-82 years) with an ECG pattern compatible with preexcitation through an anteroseptal or midseptal AP following established ECG criteria. A para-Hisian AP was defined when the location of its successful catheter ablation coincided with either the largest recordable His bundle electrogram or a His bundle potential of>0.1 mV. Patients without that definition were included in the control group. RESULTS A para-Hisian location of the AP was found in 52 patients. AP locations of the remaining 53 patients (control group) were anteroseptal (n = 39), midseptal (n = 9), and fasciculoventricular (n = 5). A negative delta wave in leads V(1) and V(2) was observed in 13 patients with para-Hisian APs (sensitivity 25%; specificity 92%). However, the sum of initial r-wave amplitudes in those leads was<0.5 mV in 44 of the patients with para-Hisian APs and in 13 patients of the control group (sensitivity 85%; specificity 75.5%; area under receiver-operator characteristic curve 0.85). CONCLUSIONS The presence of negative delta waves in leads V(1) and V(2) indicates a poor sensitivity and high specificity to detect APs with a strict definition of para-Hisian location. The sum of initial r-wave amplitudes in those ECG leads could be a useful, adjunctive marker in the noninvasive identification of these challenging APs.
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Affiliation(s)
- E González-Torrecilla
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
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Affiliation(s)
- Jayanthi N. Koneru
- From the Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Mark A. Wood
- From the Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Kenneth A. Ellenbogen
- From the Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA
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Arias MA, Pachón M, Casares-Medrano J, Puchol A. Ventricular preexcitation and atrioventricular block? Heart Rhythm 2012; 10:142-3. [PMID: 22349070 DOI: 10.1016/j.hrthm.2012.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Miguel A Arias
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain.
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VASHIST SUDHIR, SILVA JENNIFERN, VAN HARE GEORGEF, PAPEZ ANDREWL, SU WILBERW, RHEE EDWARDK. Unusually High Association of Hypertrophic Cardiomyopathy and Complex Heart Defects in Children with Fasciculoventricular Pathways. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:308-13. [DOI: 10.1111/j.1540-8159.2011.03274.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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DYRDA KATIA, FOURNIER ANNE, MARCOTTE FRANÇOIS, KHAIRY PAUL. Tachycardia in a Patient with Hypertrophic Cardiomyopathy and Suspected Ventricular Preexcitation. Pacing Clin Electrophysiol 2011; 34:104-6. [DOI: 10.1111/j.1540-8159.2010.02831.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sternick EB, Oliva A, Gerken LM, Magalhães L, Scarpelli R, Correia FS, Rego S, Santana O, Brugada R, Wellens HJ. Clinical, electrocardiographic, and electrophysiologic characteristics of patients with a fasciculoventricular pathway: The role of PRKAG2 mutation. Heart Rhythm 2011; 8:58-64. [DOI: 10.1016/j.hrthm.2010.09.081] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Accepted: 09/15/2010] [Indexed: 10/19/2022]
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30
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FARRÉ JERÓNIMO, ANDERSON ROBERTH, CABRERA JOSÉA, SÁNCHEZ-QUINTANA DAMIÁN, RUBIO JOSÉM, BENEZET-MAZUECOS JUAN, DEL CASTILLO SILVIA, MACÍA ESTER. Cardiac Anatomy for the Interventional Arrhythmologist: I.Terminology and Fluoroscopic Projections. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:497-507. [DOI: 10.1111/j.1540-8159.2009.02644.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Udink ten Cate FE, Kruessell MA, Wagner K, Trieschmann U, Emmel M, Brockmeier K, Sreeram N. Dilated cardiomyopathy in children with ventricular preexcitation: the location of the accessory pathway is predictive of this association. J Electrocardiol 2010; 43:146-54. [DOI: 10.1016/j.jelectrocard.2009.09.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Indexed: 10/20/2022]
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Electrocardiographic Characteristics of Fasciculoventricular Pathways: Analysis of Five Cases. J Arrhythm 2010. [DOI: 10.1016/s1880-4276(10)80005-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
Mutations in the PRKAG2 gene that regulates the gamma 2 subunit of the AMP-dependent protein kinase A have been associated with the development of AV accessory pathways, cardiac hypertrophy, and conduction system abnormalities. The accessory pathways described in PRKAG2 disease have mostly been AV bypass tracts, as mutations in the PRKAG2 gene disrupt the normal AV junction development. There have also been a few reports of nodoventricular tracts associated with PRKAG2 mutations, as these tracts also involve the AV junction. We describe a case of a fasciculoventricular pathway with PRKAG2 mutation suggesting a more widespread involvement of the PRKAG2 gene in the development of the cardiac conduction system.
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Affiliation(s)
- Malini Govindan
- Division of Cardiac and Vascular Sciences, St. George's University of London, London, United Kingdom.
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34
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Sternick EB. To the Editor,. J Cardiovasc Electrophysiol 2009; 20:E62; author reply E63. [DOI: 10.1111/j.1540-8167.2009.01433.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ratnasamy C, Khan D, Wolff GS, Young ML. Clinical and electrophysiological characteristics of fasciculoventricular fibers in children. Int J Cardiol 2008; 123:257-62. [PMID: 17383032 DOI: 10.1016/j.ijcard.2006.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Revised: 11/05/2006] [Accepted: 12/11/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Fasciculoventricular (FV) fiber is a rare cause for ventricular preexcitation. It is usually described as an innocent bystander pathway. There is only limited data on FV fiber in children. Hence we evaluated the clinical and electrophysiological features of FV fiber in a group of 11 children. METHODS AND RESULTS Of 215 children with manifest preexcitation who had electrophysiological studies at the University of Miami, 11 (5.1%) had characteristics of FV fiber. FV fiber was not directly responsible for any arrhythmias in these children. Three children had supraventricular tachycardia due to associated left sided Kent fiber and FV fiber was identified after the ablation of Kent fiber. One child had associated hypertrophic cardiomyopathy, another child had atrial septal defect and a third child had ventricular septal defect. The electrophysiological testing of FV fiber revealed AH interval of 40-95 ms and H-delta interval of 15-40 ms. Mapping study showed that the FV fiber was located on the right side of the heart in all patients: right anteroseptal in 9, right midseptal in 1 and it could not be mapped well in 1 as the delta wave was intermittent. We identified a discrete FV fiber depolarization spike in 9 patients, with a local FV fiber depolarization to delta wave interval of 5-20 ms (11+4 ms). CONCLUSION FV fiber is an uncommon cause for ventricular preexcitation in children and it can be associated with other conduction abnormalities and heart defects. FV fibers are commonly located at the right anteroseptal region and are not usually involved in any tachycardia. Discrete local FV fiber potential can be identified during electrophysiological testing of these patients.
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Affiliation(s)
- Christopher Ratnasamy
- Department of Pediatric Cardiology, University of Miami-Miller School of Medicine, Miami, FL 33101, USA.
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Choi YS, Choi EK, Oh S. Typical atrioventricular nodal reentrant tachycardia in a patient with fasciculoventricular pathway. J Electrocardiol 2007; 40:535-8. [PMID: 17669416 DOI: 10.1016/j.jelectrocard.2007.06.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Accepted: 06/25/2007] [Indexed: 11/19/2022]
Abstract
We report a 34-year-old female patient with preexcitation electrocardiogram and recurrent paroxysmal palpitations. Standard 12-lead electrocardiogram showed minimal preexcitation with normal PR interval and normal frontal QRS axis. The electrophysiologic study showed normal AH intervals, short HV intervals, and no change in the degree of preexcitation by rapid atrial pacing. These findings were compatible with the fasciculoventricular pathway. Typical atrioventricular nodal reentrant tachycardia with narrow QRS complex and normal HV interval was induced reproducibly by programmed electrical stimulation. Slow pathway was ablated successfully with radiofrequency catheter ablation, and then the patient remained asymptomatic during a follow-up of 12 months. Although the fasciculoventricular pathway is rare and supraventricular tachycardia in a patient with fasciculoventricular pathway may mimic Wolff-Parkinson-White syndrome, possibility of typical atrioventricular nodal reentrant tachycardia with fasciculoventricular pathway should be considered as a mechanism of supraventricular tachycardia in a patient showing preexcitation electrocardiogram.
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Affiliation(s)
- Yun-Shik Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
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Arnestad M, Opdal SH, Vege A, Rognum TO. A mitochondrial DNA polymorphism associated with cardiac arrhythmia investigated in sudden infant death syndrome. Acta Paediatr 2007; 96:206-10. [PMID: 17429906 DOI: 10.1111/j.1651-2227.2007.00022.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Long QT syndrome (LQTS) has been shown to be the cause of death in some cases originally diagnosed as sudden infant death syndrome (SIDS). Such cardiac arrhythmias have also been noted in families with mitochondrial disease, and studies indicate that mitochondrial disease could be involved in SIDS. This makes the mtDNA polymorphism T3394C interesting, as a previous study has shown it to be associated with electrocardiographic (ECG) changes after exercise in a family with LQTS, where some members harboured a KCNH2 mutation. SUBJECTS A total of 245 SIDS cases and 176 control cases. METHODS DNA was prepared from blood/tissue samples. Polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) were performed to search for the mtDNA polymorphism and KCNH2 mutation. Differences were confirmed by sequencing. RESULTS The T3394C polymorphism was found in 3 pure SIDS cases (1.5%), 2 borderline SIDS cases (4.4%), 1 case of explained death (1.6%) and 2 living control cases (1.8%) (p = 0.62). The KCNH2 mutation was not found in cases or controls. CONCLUSION The mtDNA polymorphism studied was found in a small number of SIDS cases and the frequency did not differ statistically from control subjects, making an association with increased SIDS risk unlikely.
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Sternick EB, Oliva A, Magalhaes LP, Gerken L, Hong K, Santana O, Brugada P, Brugada J, Brugada R. Response to the Editor:. J Cardiovasc Electrophysiol 2006. [DOI: 10.1111/j.1540-8167.2006.00651.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Oh S, Choi EK, Chung JW, Choi YS. Atypical atrioventricular nodal reentrant tachycardia in a patient with fasciculoventricular pathway. Heart Rhythm 2006; 3:1085-7. [PMID: 16945807 DOI: 10.1016/j.hrthm.2006.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2006] [Accepted: 05/07/2006] [Indexed: 11/22/2022]
Affiliation(s)
- Seil Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Sternick EB, Oliva A, Magalhães LP, Gerken LM, Hong K, Santana O, Brugada P, Brugada J, Brugada R. Familial Pseudo-Wolff-Parkinson-White Syndrome. J Cardiovasc Electrophysiol 2006; 17:724-32. [PMID: 16836667 DOI: 10.1111/j.1540-8167.2006.00485.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION PRKAG2 plays a role in regulating metabolic pathways, and mutations in this gene are associated with familial ventricular preexcitation, hypertrophic cardiomyopathy, and atrioventricular conduction disturbances. Clinico-pathologic and experimental data suggest the hypothesis of a glycogen storage disease. OBJECTIVE To report a unique pattern of clinical features observed in individuals with a mutant PRKAG2 from two unrelated families. METHODS AND RESULTS We studied two large families and found a total of 20 affected individuals showing a combination of sinus bradycardia, short PR interval, RBBB, intra and infrahisian conduction disturbances often requiring a pacemaker, and atrial tachyarrhythmias. Three individuals died suddenly at a young age. No patient had the Wolff-Parkinson-White (WPW) syndrome, and only two patients (10%) had myocardial hypertrophy. We performed screening of the exons and exon-intron boundaries of PRKAG2. Genetic analysis revealed a missense mutation (Arg302Gln) in the affected individuals from both families. This mutation had been described before and has been associated with the familial form of the WPW syndrome and with a high prevalence of left ventricular hypertrophy. CONCLUSION PRKAG2 mutations are responsible for a diverse phenotype and not only the familial form of the WPW syndrome. Familial occurrence of right bundle branch block, sinus bradycardia, and short PR interval should raise suspicion of a mutant PRKAG2 gene.
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Abstract
The aim of this review article is to discuss the electrocardiographic presentation of the so called variants of pre-excitation ("Mahaim fibers") during sinus rhythm and tachycardia.
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De Ponti R, Salerno-Uriarte JA. “Mahaim” fasciculoventricular fibers: Rare variant of ventricular preexcitation or subtle clinical problem? Heart Rhythm 2005; 2:7-9. [PMID: 15851256 DOI: 10.1016/j.hrthm.2004.10.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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