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Biladeau SK, Bocard B, Grell R. Anesthetic Management of an Obstetric Patient With Ehlers-Danlos and Wolff-Parkinson-White Syndromes. Cureus 2023; 15:e45486. [PMID: 37859915 PMCID: PMC10584354 DOI: 10.7759/cureus.45486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
A 31-year-old, primigravida, nullipara (G1P0) female with a past medical history of Ehlers-Danlos Syndrome (EDS), newly diagnosed Wolff-Parkinson-White Syndrome (WPW), and fetal breech presentation initially presented at 36+5 weeks gestation for an external cephalic version (ECV). The patient noted significant symptomatology related to her WPW which had worsened over the course of her pregnancy despite being started on oral metoprolol. Despite joint recommendations from the anesthesia and obstetric teams to combine the ECV with a same-day scheduled induction of labor or cesarean section, the patient declined. An epidural catheter was placed using ultrasound guidance and slowly titrated with 2% lidocaine; however, the ECV was unsuccessful. At 39 weeks gestation, the patient underwent an uncomplicated low transverse cesarean section under combined spinal-epidural anesthesia. The patient was discharged two days later in stable condition with a referral to an electrophysiologist. Here we describe the anesthetic preparation and management for an external cephalic version and subsequent cesarean section in a patient with these two rare conditions.
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Affiliation(s)
- Sara K Biladeau
- Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, Louisville, USA
| | - Braden Bocard
- Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, Louisville, USA
| | - Ryan Grell
- Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, Louisville, USA
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2
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Prevention and Management of Perioperative Dysrhythmias. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00015-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Campal JMR, Blanco ÁM, Calero LB, Rivera CL, García-Talavera CS, Olmedilla AC, Fernández JT. Comparison of Outcomes of Catheter Ablation in Asymptomatic Versus Symptomatic Preexcitation to Guidelines and Beyond. Am J Cardiol 2021; 161:51-55. [PMID: 34794618 DOI: 10.1016/j.amjcard.2021.08.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Abstract
Management of asymptomatic subjects with preexcitation remains controversial. Our objective was to analyze the reasons an electrophysiological study (EPS) was performed in an asymptomatic population referred for the procedure, and compare the results of catheter ablation between asymptomatic and symptomatic patients. Patients ≥18 years of age with preexcitation referred for an EPS and ablation were grouped as either symptomatic or asymptomatic. We analyzed in both subsets for (1) reasons for the procedure, (2) EPS results (anterograde effective refractory period of the accessory pathway, tachycardia/atrial fibrillation inducibility, anatomical localization), (3) success of the procedure, and (4) incidence of complications. We included 175 patients, 121 of which were symptomatic (39 ± 16 years) and 54 were asymptomatic (35 ± 14 years, p = NS not significant). The most frequent symptoms were palpitations (87%) and syncope (7%). EPS was performed in 44 of 54 asymptomatic patients mainly because of involvement in sports (60%) or high-risk employment (14%). Anterograde effective refractory period was significantly longer in asymptomatic patients (314 ± 55 milliseconds) than in symptomatic patients (278 ± 46 milliseconds; p <0.001). Orthodromic tachycardia inducibility was significantly higher in symptomatic than in asymptomatic patients (69% and 27%, respectively; p <0.001). A total of 170 accessory pathways (49% left free wall, 12% right free wall, 39% septal) were observed without significant differences in the anatomical location between groups. Catheter ablation was attempted in all patients, succeeding in 98% of symptomatic and 95% of asymptomatic patients, without major complications in either group. In conclusion, the reasons for invasive evaluation of asymptomatic patients with preexcitation may be outside the scope of current guidelines. Catheter ablation produces excellent results without major complications.
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Zhu K, Solin S, Deming MS. When Zebras Collide: A Case of Synchronous Wolff-Parkinson-White Syndrome and Pheochromocytoma. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e934137. [PMID: 34866133 PMCID: PMC8667631 DOI: 10.12659/ajcr.934137] [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] [Indexed: 11/12/2022]
Abstract
Patient: Male, 36-year-old
Final Diagnosis: Pheochromocytoma
Symptoms: Chest discomfort • headache • shortness of breath • symptomatic tachyarrhythmia
Medication: —
Clinical Procedure: —
Specialty: General and Internal Medicine
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Affiliation(s)
- Kaiwen Zhu
- Rochester Regional Health Internal Medicine Residency Program, Rochester, NY, USA.,Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Stacey Solin
- Department of Internal Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Madeleine S Deming
- Department of Internal Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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Yeap TB, Teah MK, Thevarajah S, Azerai S. Anaesthetic challenges in a patient with Wolff-Parkinson-White (WPW) syndrome for orchidectomy. BMJ Case Rep 2021; 14:e241176. [PMID: 33766970 PMCID: PMC7996369 DOI: 10.1136/bcr-2020-241176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 11/04/2022] Open
Abstract
Wolff-Parkinson-White (WPW) syndrome is an extremely rare congenital cardiac conduction disorder. It is due to an aberrant pathway between the atrium and ventricle. This manuscript entails a man with an underlying WPW who was posted for an elective orchidectomy. We discussed the important perioperative precautions to prevent the precipitation of acute cardiac events.
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Affiliation(s)
- Tat Boon Yeap
- Medicine Based Disciplines Department, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Ming Kai Teah
- Department of Anaesthesia and Intensive Care Unit, Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia
| | | | - Salamah Azerai
- Department of Anaesthesia and Intensive Care Unit, Hospital Queen Elizabeth 2, Kota Kinabalu, Sabah, Malaysia
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Infraclavicular Brachial Plexus Block and Sugammadex Use in a Paediatric Patient with Wolff-Parkinson--White Syndrome. Rom J Anaesth Intensive Care 2020; 27:19-22. [PMID: 34056120 PMCID: PMC8158309 DOI: 10.2478/rjaic-2020-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Wolff–Parkinson–White (WPW) syndrome is a rare disease that can cause various patterns of tachyarrhythmias. The main goal of anaesthesiologists for the perioperative anaesthetic management of WPW patients must be to avoid sympathetic stimulation and prevent tachyarrhythmias. Case A 9-year-old male patient with a diagnosis of WPW syndrome, who underwent emergency surgery for supracondylar humerus fracture, is presented. General anaesthesia in combination with infraclavicular brachial plexus (ICBP) block was performed successfully without any complications. For the reversal of neuromuscular block, sugammadex was uneventfully used. Intraoperative sympathetic discharge due to surgical intervention was prevented with ICBP block. The ICBP block has also provided good postoperative analgesia. Conclusions Sugammadex is a good alternative for the reversal of neuromuscular blocks to avoid the undesirable effects of cholinergic drugs. Peripheral regional blocks that require relatively large doses of local anaesthetics can be safely performed with utmost attention in paediatric WPW patients.
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Staikou C, Stamelos M, Stavroulakis E. Perioperative management of patients with pre-excitation syndromes. Rom J Anaesth Intensive Care 2018; 25:131-147. [PMID: 30393770 PMCID: PMC6211613 DOI: 10.21454/rjaic.7518.252.stk] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/11/2018] [Indexed: 11/27/2022] Open
Abstract
Patients with pre-excitation abnormalities are at a high risk for life-threatening perioperative arrhythmias. In Wolff-Parkinson-White syndrome, the anaesthetics used for invasive diagnostic testing/ablation, should not affect cardiac electrophysiology; propofol, sevoflurane, fentanyl, sufentanil, alfentanil are suitable. In non-ablative surgery, propofol, sevoflurane, isoflurane, fentanyl, alfentanil, sufentanil have been used safely. Among neuromuscular blockers, cis-atracurium, rocuronium and vecuronium are good choices. Ketamine, pancuronium and pethidine should be avoided because of their sympathomimetic actions. Anticholinergic/ anticholinesterase combinations for neuromuscular block reversal should preferably be omitted, while sugammadex seems more attractive. In regional anaesthesia, addition of epinephrine and high sympathetic blocks should be avoided. Hypotension should be treated with pure alpha-adrenergic agonists. Other pre-excitation abnormalities associated with different accessory pathways are the Mahaim Fiber and Lown-Ganong-Levine syndrome. Sympathetic activation should be avoided. Total intravenous anaesthesia with propofol probably represents the safest option. A careful anaesthetic plan and close cooperation with cardiologists are mandatory for successful management.
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Affiliation(s)
- Chryssoula Staikou
- Department of Anaesthesiology, Aretaieio Hospital, Medical School, University of Athens, Athens, Greece
| | - Mattheos Stamelos
- Department of Anaesthesiology, Aretaieio Hospital, Medical School, University of Athens, Athens, Greece
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Ferro CRC, de Assis Costa F, Mendonça MA, Rivera I, Ferro FPN, Barbosa JM, Filho ADO, Póvoa R, Cirenza C, de Paola AAV. Correlation of accessory pathway location with gender and their manifest or concealed presentation. Int J Cardiol 2016; 216:43-5. [PMID: 27140335 DOI: 10.1016/j.ijcard.2016.04.099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/11/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Atrioventricular reentrant tachycardias account for approximately one third of cases referred for electrophysiological study (EPS). The anatomical substrate responsible for the reentry is an accessory pathway (AP) able to conduct the electrical stimulus in an anterograde, retrograde or bidirectional manner. OBJECTIVE To evaluate the correlation of AP location with the male and female genders and AP clinical presentation, whether manifest or concealed. METHODS Retrospective observational study including 942 consecutive patients, all diagnosed with EPS-confirmed AP from January 1994 to December 2008. APs were classified into eight anatomical groups: left lateral (LL), left posterior (LP), left posteroseptal (LPS), right posteroseptal (RPS), right midseptal (RMS), right anteroseptal (RAS), right lateral (RL), and right posterior (RP). RESULTS Of the 942 patients, 52.6% were males. The mean age was 31.2±13.8years. As regards gender, APs were more prevalent among men. However, a statistically significant difference was observed only in the LPS (p=0.029) and RL (p=0.003) regions. In relation to the form of presentation of AP, the manifest form was more frequent than the concealed form in six of the eight regions studied, except for the LL and LPS regions. CONCLUSION AP predominated in males and the manifest form was more frequent than the concealed form in most of the regions studied.
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Affiliation(s)
| | | | | | - Ivan Rivera
- Universidade Federal de Alagoas, Universitary Hospital of Alagoas, Brazil
| | | | | | | | - Rui Póvoa
- Universidade Federal de Sao Paulo, Cardiology, Brazil
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Seifert PC, Yang Z, Ilkhanoff L. Crisis Management of Unstable Tachycardia in the OR. AORN J 2016; 103:422-9. [DOI: 10.1016/j.aorn.2016.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 02/17/2016] [Indexed: 11/28/2022]
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Deviseti P, Pujari VS. Spinal Anaesthesia is Safe in a Patient with Wolff-Parkinson-White Syndrome Undergoing Evacuation of Molar Pregnancy. J Clin Diagn Res 2016; 10:UD01-2. [PMID: 27042562 DOI: 10.7860/jcdr/2016/15751.7182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 12/07/2015] [Indexed: 11/24/2022]
Abstract
Wolff-Parkinson-White (WPW) syndrome is an uncommon cardiac condition where there is an abnormal band of atrial tissue connecting atria and ventricles which can electrically bypass atrioventricular node. The anaesthetic management in these patients is challenging as life threatening complications can occur perioperatively like paroxysmal supraventricular tachycardia and atrial fibrillation. Also, regional anaesthetic technique like subarachnoid block is a safe and cost effective alternative to general anaesthesia as it avoids polypharmacy. We report the successful anaesthetic management of Wolff Parkinson White syndrome in a primi with hydatiform mole posted for suction and evacuation.
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Affiliation(s)
- Pravalika Deviseti
- Post Graduate Student, Department of Anesthesiology, M.S. Ramaiah Medical College & Hospitals , New BEL Road Bangalore, India
| | - Vinayak S Pujari
- Associate Professor, Department of Anesthesiology, M.S. Ramaiah Medical College & Hospitals , New BEL Road Bangalore, India
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Wolff-Parkinson-White Syndrome in a Term Infant Presenting With Cardiopulmonary Arrest. Adv Neonatal Care 2016; 16:44-51. [PMID: 26742096 DOI: 10.1097/anc.0000000000000246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Wolff-Parkinson-White syndrome is a congenital abnormality of the cardiac conduction system caused by the presence of an abnormal accessory electrical pathway between the atria and the ventricles. This can result in intermittent tachyarrhythmias such as supraventricular tachycardia. In rare occasions, sudden death may occur from atrial fibrillation with rapid ventricular conduction. Supraventricular tachycardia typically has a sudden onset and offset, classified as a paroxysmal arrhythmia. Because of the variable occurrence, Wolff-Parkinson-White syndrome may go undiagnosed in the immediate newborn period. PURPOSE To highlight arrhythmia as a possible cause of sudden decompensation in infants. CASE FINDINGS/RESULTS The clinical presentation of this infant is complex and a number of potential diagnoses were considered. Preexcitation on electrocardiogram resulted in the diagnosis of Wolff-Parkinson-White syndrome. IMPLICATIONS FOR PRACTICE Nurses caring for infants should be alert to tachycardia and irregularities of the heart rate, including those in the prenatal history, and should report them for evaluation. While all parents should be taught to watch for signs of illness, parents of infants with Wolff-Parkinson-White have additional learning needs, including recognizing early signs and symptoms of heart failure.
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Sarsam S, Sidiqi I, Shah D, Zughaib M. Concomitant Wolff-Parkinson-White and Atrioventricular Nodal Reentrant Tachycardia: Which Pathway to Ablate? AMERICAN JOURNAL OF CASE REPORTS 2015; 16:872-5. [PMID: 26655223 PMCID: PMC4678921 DOI: 10.12659/ajcr.894647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient: Male, 54 Final Diagnosis: WPW and AVNRT Symptoms: Palpitations • shorthness of breath Medication: — Clinical Procedure: EP Study/Radiofrequency Ablation Specialty: Cardiology
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Affiliation(s)
- Sinan Sarsam
- Department of Cardiology, Providence Hospital and Medical Center, Southfield, MI, USA
| | - Ibrahim Sidiqi
- Department of Cardiology, Providence Hospital and Medical Center, Southfield, MI, USA
| | - Dipak Shah
- Department of Cardiology, Providence Hospital and Medical Center, Southfield, MI, USA
| | - Marcel Zughaib
- Department of Cardiology, Providence Hospital and Medical Center, Southfield, MI, USA
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