No abstract available.
Accessory Atrioventricular Bundle ; Electrocardiography ; Tachycardia*

Accessory Atrioventricular Bundle ; Bundle of His ; surgery ; Child ; Cryosurgery ; Humans ; Wolff-Parkinson-White Syndrome

A 41-year-old male was presented with drug-resistant supraventricular tachycardia. Electrophysiological study confirmed that the supraventricular tachycardia was caused by dual atrioventricular nodal pathways and a left lateral accessory pathway (AP). The left lateral AP was resistant to traditional endocardial ablation, but was successfully eliminated by radiofrequency ablation via the intracoronary sinus approach.
Accessory Atrioventricular Bundle ; Catheter Ablation ; Humans ; Male ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Supraventricular

The Wolff-Parkinson-White (W-P-W) syndrome and variants are called the pre-excitation sydrome. The prevalence has been estimated 0.15 pereent. Advances in electrophysiological mapping and increasing sophistication of surgical techniques have been resulted in an increasing role for definitive surgical treatment. The anesthetic management of patients with this syndrome is aimed at avoiding tachyarrhythmias. Anesthesia for surgical ablation of accessory conducting pathways was successfully performed under general balanced technique with fentantyl, vecuronium, isoflurane which were avoid of sympathetic stimulation.
Accessory Atrioventricular Bundle ; Anesthesia ; Humans ; Isoflurane ; Prevalence ; Tachycardia ; Vecuronium Bromide ; Wolff-Parkinson-White Syndrome

OBJECTIVES: Among the current therapeutic options for paroxysmal supraventricular tachycardias, only surgery and ablative techniques are curative. However, surgery is associated with substantial cost, morbidity, and rarely death. Recently, catheter ablation techniques have been developed to treat paroxysmal supraventricular tachycardias. These techniques are effective and low-risk curative treatment for supraventricular tachycardias. This article shall describe our clinical experiences in radiofrequency catheter ablation for supraventricular tachycardias and review the literature. METHODS: The study population consisted of 154 patients with supraventricular tachycardias from January 1993 to August 1995. Eighty one patients were men and seventy three patients were women, and their mean age was 41.29 +/- 15.41 years. Radio-frequency currents(mean) were applied through a catheter electrode positioned against the mitral or tricuspid annulus or a branch of the coronary sinus or atrioventricular node. RESULTS: Among 154 patients, the mechanisms for paroxysmal supraventricular tachycardias were found to be atrioventricular reentrant tachycardia involving a concealed accessory pathway in 51(33.1%), Wolff-Parkinson-White syndrome in 57(37%), and atrioventricular nodal reentrant tachycardia in 46 (29.9%). Successful outcomes were achieved in 46 of 46 patients(100%) with atrioventricular nodal reentrant tachycardia, 7 of 8 patients(87.5%) with double accessory pathways, 69 of 72 patients(95.8%) with left-sided accessory pathway, and 19 of 28 patients (67.9%) with right-sided accessory pathway. Total 141 of 154 patients(91.6%) with supraventricular had a successful outcome with radio-frequency current application(mean). CONCLUSIONS: Radiofrequency catheter ablation techniques are highly effective in ablating accessory pathways or modifying atrioventricular node, with low morbidity and no mortality.
Accessory Atrioventricular Bundle ; Atrioventricular Node ; Catheter Ablation* ; Catheters ; Coronary Sinus ; Electrodes ; Female ; Humans ; Male ; Mortality ; Tachycardia ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Supraventricular ; Wolff-Parkinson-White Syndrome

Radiofrequency (RF) refers to the portion of the electromagnetic spectrum in which electromagnetic waves can be generated by feeding an alternating current to an antenna. RF energy is electrically conducted, not radiated, during catheter ablation, and RF rarely induces rapid polymorphic arrhythmias. When using RF to measure lesion size in a steady state, the lesion size is proportional to the temperature measured at the tissue-electrode interface and the RF power amplitude. Focal ablation using RF is the treatment of choice for all supraventricular tachyarrhythmias, including AV nodal reentry, tachycardias with concealed accessory pathways, incessant automatic atrial tachycardia, isthmus dependent atrial flutter, and other macroreentrant atrial tachycardias. The isolation of pulmonary veins by RF energy has been successful for paroxysmal atrial fibrillation.
Accessory Atrioventricular Bundle ; Arrhythmias, Cardiac ; Atrial Fibrillation ; Atrial Flutter ; Catheter Ablation* ; Catheters* ; Electromagnetic Radiation ; Magnets ; Pulmonary Veins ; Tachycardia*

PURPOSE: Catheter ablation using radiofrequency currents have been proven to be an effective and safe tool for the treatment of adult patients with accessory atrioventricular pathways. This study was designed to analyze the efficacy of this method in childern and adolescents. METHODS: Using radiofrequency currents, cathether ablation of an accessory pathway was performed in 54 patients (mean age 11.8 years) with drug-refractory supraventricular tachycardia (51 patients in Georg-August University and 3 patients in Choong Ang Gil General Hospital). Criterias for RF current ablation were as following: precise recording of AP potentials, early ventricle activation relative to the onset of delta wave and stable local electrocardiogram. RESULTS: In 33 of 36 (91.6%) patients with left-side accessory pathways and in 15 of 18 (83.3%) patients with right-side accessory connections, conduction over these pathways was interrupted. CONCLUSION: Cathter ablation using radiofrequency current is a highly effective method for the definitive treatment of supraventricular tachycardia in children and adolescents. Even though cathter ablation by using radiofrequency current is safer in comparison to using direct currents, this procedure should be done only by a specialist. Drug therapy does not cure or offers temporary treatment, but the major benefit of radiofrequency catheter ablation is its potential as a cure. Recently, catheter ablation using radiofrequency currents has been used as the primary treatment for supraventricular tachycardia, because the opportunity to eliminate a chronic disease is especially appealing to children and then family.
Accessory Atrioventricular Bundle ; Adolescent* ; Adult ; Catheter Ablation* ; Catheters* ; Child* ; Chronic Disease ; Drug Therapy ; Electrocardiography ; Humans ; Specialization ; Tachycardia, Supraventricular*

In patients with Ebstein's anomaly, the localization of accessory pathways may be impeded by abnormal local electrograms recorded along the atrialized right ventricle and by the presence of multiple accessory pathways. We report a case of 50-year-old man diagnosed with Ebstein's anomaly with Wolff-Parkinson-White syndrome who presented with recurrent palpitations. He was referred to our institution for radiofrequency catheter ablation of paroxysmal supraventricular tachycardia. Transthoracic echocardiography revealed the tricuspid valve displaced into the right ventricle, consistent with Ebstein's anomaly. The electrophysiology study showed a right posterolateral accessory pathway. The optimal ablation site was located not in the atrioventricular line of the atrialized ventricular portion, but in the original atrioventricular line.
Accessory Atrioventricular Bundle ; Catheter Ablation ; Ebstein Anomaly* ; Echocardiography ; Electrophysiology ; Heart Ventricles ; Humans ; Middle Aged ; Tachycardia, Supraventricular ; Tricuspid Valve ; Wolff-Parkinson-White Syndrome

PURPOSE: The aim of the present study was to evaluate the characteristics of electrophysiologic studies (EPS) and radiofrequency ablation (RFA) performed in subjects aged less than 30 years with Wolff-Parkinson-White (WPW) syndrome, particularly pediatric patients under 18 years of age, based on our experience. METHODS: Two hundred and one consecutive patients with WPW syndrome were recruited and divided to 3 groups according to age: group 1, 6 to 17 years; group 2, 18 to 29 years; and group 3, 30 to 60 years. The clinical, electrophysiological, and therapeutic data for these patients were evaluated by a retrospective medical record review. RESULTS: A total of 73 (36%) of these patients were <30 years of age. Although there were more males than females in group 2 (male:female, 31:11), there was no sex difference in group 1 (male:female, 16:15). Left accessory pathway was detected less frequently in group 1 (32%, 10/31) than in group 2 (57%, 24/42) and group 3 (63%, 81/128) (P=0.023 and P=0.002, respectively). CONCLUSION: The present study describes several different electrophysiological characteristics in children and adolescents with WPW syndrome. Therefore, when EPS and RFA are performed in children and adolescence with WPW syndrome, we recommend that these characteristics be considered.
Accessory Atrioventricular Bundle ; Adolescent ; Aged ; Catheter Ablation ; Child ; Electrophysiology ; Female ; Humans ; Male ; Medical Records ; Retrospective Studies ; Sex Characteristics ; Wolff-Parkinson-White Syndrome

BACKGROUND: Antidromic reentrant tachycardia(ART), in which an accessory atrioventricular pathway is used as the anterograde limb of an atrioventricular reentrant tachycardia, has been documented clinically in less than 10% of patients with the Wolff-Parkinson-White(WPW) syndrome. The wide QRS complex makes the distinction between antidromic AV reentrant tachycardia and ventricular tachycardia somewhat difficult. The purpose of this study is to evaluate the clinical and eoectrophysiologic characteristics of the antidromic reentrant tachycardia. METHODS AND RESULTS: During the electrophysiologic study of 355 patients, from December 1986 to April 1995, referred for evaluation of Wolff-Parkinson-White syndrome, 18(5.1%) patients had preexcited reciprocating tachycardia. 1) The age of the antidromic reentrant rnchycardia patients ranged from 15 to 53 years(28+/-12) and the mean age was younger than that of orthodromic reentrant tachycardia(ORT)patients(p<0.05). 2) Thirteen were male patients, five were females. 3) There were associated heart diseases in 3 cases. Two patients had Egstein's anomaly and ond had valvular heart disease. 4) The locations of accessory pathways(APs) documented on surface ECG were 7 left side(39%), 9 right side(50%)< 1 posteroseptal side(5.5%), and 1 anteroseptal side. 5) Nultiple bypass tracts were documented by electrophysiologic study in 7/18(38.9%) cases with ART, more common than cases with ORT(20/337(5.9%))(p<0.05). 6) 25 accessory pathways were documented by EPS in 18 patients(10 ;eft side, 11 right side, 2 posteroseptal side and 2 anteroseptal side). ART patients had more right sided AP(11/25,44%) than those with ORT(98/357, 27.5%), but ART patients had less posteroseptal AP(2/25, 8%)than those with ORT(63/357, 17.6%). 7) The types of ECG patterns naturally occurred were LBBB(11 cases), RBBB(6cases), and atrial fibrillation(4 cases). 8) The types of induced tachycardia in electrophysiologic study were 11 antidronic reentrant tachycardia, 10 orthodromic reentrant tachycardia, 7 reentrant tachycardia using two accessory bypass tracts, 3 AVnodal reentrant tachycardia, and 5 atrial fibrillations. CONCLUSION: ART patients were younger and had more multiple tracts than those with ORT. ART patients had less posteroseptal AP than ORT patients and more right sided AP than ORT patients. The posteroseptal AP was used as retrograde limb only.
Accessory Atrioventricular Bundle ; Atrial Fibrillation ; Electrocardiography ; Extremities ; Female ; Heart Diseases ; Heart Valve Diseases ; Humans ; Male ; Tachycardia ; Tachycardia, Reciprocating ; Tachycardia, Ventricular ; Wolff-Parkinson-White Syndrome