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At least 19 recordsLinked to original sources
PubMed1976

Bipolar catheter electrograms for study of retrograde atrial activation pattern in patients without pre-excitation syndromes.

The sequence of retrograde atrial activation of premature ventricular beats was studied in 12 patients without pre-excitation syndrome. Forward and retrograde AV nodal conduction times were within normal limits. The septal low right atrial (LRA2) deflection was inscribed 25 to 55 ms (ave: 37.9 ms) before the low left atrial (LLA2) electrogram and 35 to 75 ms (ave: 53.7 ms) ahead of the high right atrial (HRA2) deflection. LLA2 preceded HRA2 in 8 patients, more or less coincided with HRA2 in 3 cases, and was inscribed 10 ms ahead in 1 patient. In all cases a decrease in the coupling (St1-St2) interval resulted in a proportional increase of the septal LRA1-LRA2, LLA1-LLA2, and HRA1-HRA2 intervals. Atrial echoes occurring in 3 cases had a sequence of arrival of excitation at the recording sites which was similar to the ones shown by the same patients during ventricular pacing. This is in keeping with the existence of an upper common pathway located above the area where functional longitudinal dissociation occurred. Thus, it is concluded that impulses emerging from the AV node in a retrograde direction reach the septal low right atrium before they activate the explored low left atrial sites, regardless as to whether they arise in the ventricles or in the atria.

Arrhythmias, Cardiac↗
PubMed1976

His bundle recordings in a case of complete atrioventricular block combined with pre-excitation syndrome.

In a patient with complete A-V block suffering from attacks of dizziness an intermittent A-V conduction with a short P-R interval and a delta wave of the conducted ventricular complex were observed. After accelerating the sinus rate by atropine and by exercise, one-to-one conduction was established with QRS complexes of WPW type A configuration. His bundle recordings revealed a complete block within the normal conduction system at the level of the A-V node. A slow junctional rhythm with a normal H-V interval was activating the ventricle. During atrial pacing a one-to-one conduction through an accessory pathway could be documented at cycle lengths between 800 and 380 msec. sandwiched in between zones of complete block at smaller or longer cycle lengths. During ventricular stimulation no retrograde V-A conduction could be observed. The findings support the thesis of at least two functionally different A-V pathways in patients with pre-excitation syndrome.

Arrhythmias, Cardiac↗
PubMed1976

[Effects of verapamil on sinusal function and on atrioventricular conduction along normal and abnormal pathways, in patients with pre-existing troubles of excitation conduction (author's transl)].

Effects of verapamil (5 mg i.v.) on excitation conduction in 20 patients who already had a basic alteration (7 with ventricular pre-excitation syndrome) were studied by His electrogram, during spontaneous sinusal rhythm and atrial electrostimulation in increasing frequencies. In 4 cases, a test crossed with atropine was carried out. The effects of the drug on the effective refractory period of the A-V node and the anomalous tract in 3 patients with W.P.W. syndrome of Kent's bundle were studied. The effects were: no significant modifications in the sinusal frequency; increase in the corrected preautomatic pause only in cases with sick sinus node syndrome and serious basic compromise of the sinus node function; slowing down of A-V conduction in the supra-hisian area and increase of the effective refractory period of the A-V node; no modification of the intra-atrial conduction, or the under-hisian and intraventricular A-V conduction; uneven slowing down of conduction along the anomalous tract of the pre-excitation syndrome of the James bundle; modification of the effective refractory period of the anomalous tract of the Kent bundle type, variable from case to case. On the basis of the electrophysiological properties, the possibilities and limits of use of the drug in sick sinud node syndrome in the common supraventricular paroxymal tachycardias, in atrial fibrillation, atrial flutter and arrhythmias of the ventricular pre-excitation syndrome are emphasized.

Adult↗
PubMed1975

[Verapamil in the study and treatment of supraventricular tachycardias, with special reference to pre-excitation].

Verapamil is a novel antiarrhythmic agent which appears to act as a calcium-ion antagonist, blocking calcium transport across the myocardial cell membrane. It was given intravenously, in a dose of 10 mg, to thirty-two patients suffering from paroxysmal supraventricular tachycardia, and sinus rhythm was achieved promptly in all. Identical results were obtained in a further ten patients with supraventricular tachycardias associated with the Wolff-Parkinson-White or other pre-excitation syndromes. In a separate group of eighteen patients in whom A-V junctional tachycardias were induced during intracardiac electrography, conversion to sinus rhythm was achieved in fifteen patients, with prolongation of the cycle length in the others. Circus-movement tachycardias were induced in eight patients with the Wolff-Parkinson-White syndrome, and conversion to sinus rhythm was achieved in seven. The results were less consistent in patients with other supraventricular arrhythmias including ectopic atrial tachycardia and atrial flutter, and, in the single patient with supraventricular and ventricular tachycardias, only the former was controlled. In the single patient with atrial fibrillation complicating the wolff-Parkinson-White syndrome who received Verapamil, sinus rhythm was restored. Side effects were few and mild, with rare exceptions of profound hypotension, bradycardia and asystole; their management is discussed, and reasons are advanced why their occurrence is likely to be related either to the concomitant administration of beta-adrenergic blockers or to the presence of sinoatrial disease. It appears that Verapamil is particularly suitable for the treatment of supraventricular tachycardias due to a circus movement as calcium antagonism is likely to be most effective in the N region of the atrioventricular node.

Adrenergic beta-Antagonists↗
PubMed1979

[Medical management of tachycardias (author's transl)].

Guidelines for a step-wise plan of treatment of tachycardias have been compiled based on clinical empirical experience and with the aid of surface electrocardiograms, intracardial electrograms and stimulation techniques. The plan is primarily with the aid of surface electrocardiograms, intracardial electrograms and stimulation techniques. The plan is primarily oriented with respect to the antiarrhythmic efficacy, the adverse reactions and the practicability of the respective agents. Any type of tachycardia, including premature atrial or ventricular contractions, may be regarded as indication for treatment. Treatment is not indicated only in those asymptomatic patients with rare and evanescent tachycardias and in those with less than 300 premature contractions per hour. Beta-adrenergic blockers are the drugs of choice for the persistent sinus tachycardia. Should the latter agents be contraindicated, propafenon, amiodarone or aprindine may be administered. Verapamil and/or digitalis are indicated only for suppression of paroxysmal sinus tachycardias. Atrial premature contractions are best managed with guinidine or disopyramid. An acute reduction of rapid ventricular rates associated with atrial tachycardias, atrial flutter or fibrillation can best be attained through the administration of verapamil prior to digitalis or beta-adrenergic blockers. Re-establishment of sinus rhythm and prophylactic suppression of the latter should be undertaken with quinidine or disopyramid in combination with digitalis and/or either a beta-adrenergic blocker or intravenously-administered verapamil. Verapamil is the drug of choice for initial management of AV-junctional tachycardia for which a combination with digitalis may be considered. An alternative combination is that of a beta-adrenergic blocker and digitalis. For the acute treatment of ventricular tachycardias, lidocain has proved most effective. Although ajmaline and/or propafenon may be given should no response be obtained, electrical cardioversion would be more appropriate. To prevent ventricular tachycardia or when treatment is indicated for ventricular premature beats, ajmaline, propafenon, quinidine, disopyramid or mexiletine, occasionally in combination with a beta-adrenergic blocker should be employed. Verapamil and/or ajmaline, are usually very effective for termination of reciprocal tachycardias. Ajmaline or propafenon in combination with a beta-adrenergic blocker is recommended for the prophylactic treatment of reciprocal tachycardia. In patients who additionally have bradycardia, prolonged QT-intervals or pre-excitation syndromes, the guidelines should be modified accordingly.

Anti-Arrhythmia Agents↗
PubMed1977

[Correlation between the orientation of the data wave and the topography of pre-excitation in the Wolff-Parkinson-White syndrome].

A comparison between the epicardial siting of the zone of pre-excitation of the ventricle in Wolff-Parkinson-White syndrome and the ECG has allowed us to distinguish 6 topographical types, according to the orientation of the delta wave in the horizontal plane, and especially in the frontal plane which is often ignored: right anterior, left lateral, right of left anterior paraseptal, and right or left posterior paraseptal. The association of a heart defect with ventricular hypertrophy, or the coexistence of several associated accessory pathways prevents such correlation and makes it imperative to carry out intracavitary investigation and epicardial mapping to localise the accessory pathway if surgery is contemplated.

Electrocardiography↗
PubMed1978

[Indications and risks of anti-arrhythmia treatment with propafenone (author's transl)].

Propafenone, a new anti-arrhythmia drug, was given at an average dose of 70-140 mg (1-2 mg/kg body-weight) to 124 patients with various types of cardiac arrhythmias. It proved successful in patients with ectopic beats and tachycardias of atrial or ventricular origin. Ectopic beats were suppressed in 40 of 81 patients, while sinus rhythm was restored in 15 of 19 patients with paroxysmal tachycardias. On the other hand, sinus rhythm was restored in only 5 of 22 patients with atrial tachy-arrhythmias, while in most of the others in this group the heart rate decreased markedly during propafenone injection. The effect of propafenone was on atrial and ventricular myocardium and on the conduction system, lowering the discharge rate of sinus node and ectopic pacemakers. ECG signs of pre-excitation disappeared in 4 of 9 patients with WPW syndrome given the drug. Propafenone may prolong atrioventricular and intraventricular conduction, as well as cause a transitory decrease in cardiac function and a fall in systemic arterial blood pressure. It should, therefore, not be given to patients in severe heart failure, hypotension or shock, or with high-degree atrioventricular, intraventricular or sinoatrial block.

Adult↗
PubMed1978

Epicardial mapping in the Wolff-Parkinson-White syndrome.

Epicardial mapping provides a method for defining antegrade and retrograde sites of pre-excitation. It is best undertaken only after a careful, detailed preoperative electrophysiological study has been performed. The potential pitfalls of the technique are many and technical expertise must be constantly available to maintain a functioning system. For these reasons, it is not likely to lend itself to widespread application. The same techniques can be applied to localization of the site of origin of atrial or ventricular dysrhythmias, localization of myocardial ischemia and infarction, as well as to differentiate between epicardial delays due to conduction delay and those caused by intramural myocardial delay.

Arrhythmias, Cardiac↗
PubMed1976

An echocardiographic study of interventricular septal motion in the Wolff-Parkinson-White syndrome.

Echocardiographic studies of interventricular septal motion were performed in 26 consecutive patients with the Wolff-Parkinson-White (WPW) syndrome and in ten normal subjects. All patients with types A or B pre-excitation were subclassified into groups I to IV on the basis of their electrocardiogram utilizing the method of Boineau and associates. In all 14 patients with type A (Group III or IV) pre-excitation, the motion of the interventricular septum and posterior left ventricular wall motion were normal. However, in 11 patients with type B (Group I) WPW an abnormal septal movement was noted. This was characterized in ten patients by an early systolic posterior motion, a subsequent anterior movement in mid systole, and the usual posterior septal motion beginning in late systole. In eight patients, including the one without early systolic posterior movement of the septum, the late systolic posterior movement was interrupted by a prominent septal notch. On e patient with type B (Group II) WPW was studied and exhibited normal septal and posterior wall motion. In one patient with a spontaneous change in the QRS complex from normal to a type B (Group I) WPW pattern, the septal motion was initially normal and abruptly changed following the first WPW beat. The onset of abnormal interventricular septal motion with type B pre-excitation QRS complexes strongly suggests that abnormal septal movement may be related to an altered sequence of ventricular depolarization during right ventricular pre-excitation.

Action Potentials↗
PubMed1976

Body-surface maps of heart potentials: tentative localization of pre-excited areas in forty-two Wolff-Parkinson-White patients.

Heart potentials were recorded from the entire chest surface in 42 patients suffering from Wolff-Parkinson-White syndrome. We were able to identify six types of surface maps, according to the location of the potential maximum and minimum during the delta wave. For each of these types we suggested the most likely location of the pre-excited region around the A-V rings (types 1 to 5) or in the interventricular septum (type 6). In 13 patients belonging to Types 1, 2, 3, 5 and 6 our hypotheses were in agreement with intracardiac recordings, epicardial maps or surgical results obtained by others. Isopotential surface maps provide more information on the location of the pre-excited area than conventional ECGs, particularly when these exhibit intermediate features between Types A and B.

Action Potentials↗
PubMed1977

[Auricular fibrillation with ventricular tachycardia. Surgical section of a left lateral bundle of Kent].

The authors report the case of a man of 22 years, with no previous cardiac history, in whom a Wolff-Parkinson-White syndrome was discovered during the course of this first episode of atrial fibrillation with a ventricular rate of 300-350/mn; investigation (vecto-cardiogram, intra-cavitory ECG) showed the presence of a short circuit of the Kent type, with a high permeability, and localised in the left lateral position; this was confirmed by pericardial cartography. After the surgical division of the accessory pathway, the electrical phenomenon of pre-excitation disappeared. The current possibilities of operating on cases of a Wolff-Parkinson-White syndrome justify carrying out a scrupulous electrophysiological study of each case, so that any accessory pathway can be precisely localised, and its refractory period determined; thus a pathway of preexcitation localised in the left lateral position, and having a short refractory period leading to a high ventricular rate under atrial fibrillation conditions, constitutes an indication for operation which may be urgent.

Adult↗
PubMed1976

Echocardiography in Wolff-Parkinson-White syndrome.

Twenty-six patients with Wolff-Parkinson-White (WPW) syndrome were studied by echocardiography. They were classified into the following WPW types: anterior right ventricular pre-excitation (Type I) - six patients; posterior right ventricular pre-excitation (Type II) - six patients; posterior left ventricular pre-excitation (Type III) - fourteen patients. Twenty-three patients were in WPW at the time of study. Four patients with Type I WPW had abnormal systolic motion of the interventricular septum: three paradoxical and one flat. Patients with Type II and Type III WPW had no septal motion abnormalities related to pre-excitation. Three patients had intermittent WPW, Type III; in all three only minor changes in normal septal motion were apparent on WPW beats. Associated cardiac abnormalities were evident in six patients: two mitral prolapse (one Type II WPS and one Tpe III); one idiopathic hypertrophic subaortic stenosis (Type III); one congestive cardiomyopathy (Type III); one hypertrophic nonobstructive cardiomyopathy (Type I); and one atrial septal defect (Type II). We conclude that abnormal interventricular septal motion may occur with Type I WPW abnormality. Other abnormalities are detectable by echocardiography in a high proportion of WPW patients, but do not appear to be associated with any single Wolff-Parkinson-White type.

Cardiomegaly↗
PubMedDate not supplied

[Surgical treatment of Wolff-Parkinson-White syndrome (author's transl)].

This report relates the surgical experience with 75 patients with WPW. The patients' symptoms were either SVT alone or SVT associated with a pathway with a lethal potential. In some, the Kent pathway caused SVT but did not cause cause pre-excitation. In others, multiple pathways were found. Success has been achieved in 35 of the last 36 patients with freewall pathways treated by surgery. Problems still remain with the posterior septal group. The indications for operation have been broadened to include all patients with significant symptoms.

Adult↗
PubMed1977

[Negative retrograde P wave in D1, sign of left postero-lateral Kent bundle].

A negative P wave in D1 with a mean atrial vector which is horizontal or descending in the frontal plane, occurring during paroxysmal tachycardial due to reciprocal rhythm or after ventricular stimulation suggests atrial depolarisation which starts in the left auricle at some distance from the A-V node and near the pulmonary veins. In the absence of an external anterograde ventricular pre-excitation, such P waves may indicate the presence of a hidden bundle of Kent posterolaterally on the left, allowing retrograde conduction during the tachycardia by a reciprocal rhythm.

Electrocardiography↗
PubMed1978

Unusual mechanism in the initiation of the paroxysmal supraventricular tachycardia in a patient with WPW syndrome.

A heretofore unreported unusual mechanism in the initiation of the paroxysmal supraventricular tachycardia (PSVT) in a patient with WPW (Wolff-Parkinson-White) syndrome was observed using His bundle recordings. The patient initially had some degree of AV conduction disturbance at the level of the AV node. A premature atrial impulse initially activated the ventricle exclusively through the accessory pathway and the same impulse re-excited the ventricle via the AV nodal-His axis after finishing the pure pre-excitation with marked prolongation of the AH and the HV intervals. After finishing this double ventricular response it traversed to the atrium to produce the PSVT.

Atrioventricular Node↗