Since its initial description in 1930, the preexcitation or Wolff-Parkinson-White(W-P-W) syndrome is characterized by a special electrocardiographic pattern and various paroxysmal tachyarrhythmia, which was found to have reciprocating tachycardia frequently. The W-P-W syndrome develops when some part of a ventricle is activated earlier than normal conduction pathway, and described as one type of ventricular preexcitation syndromes by Durrer (1974). The diagnostic criteria of the W-P-W syndrome are 1) initial slurring (delta wave) of the QRS complex, 2) short P-R interval, 3) widened QRS complex and 4) secondary T wave change. The initial slurring of the QRS complex (delta wave) which is the most important finding of preexcitation syndrome results from a premature activation of a portion of the ventricle through an accessary pathway which bypasses the A-V node and bundle. These accessary conduction fiber includes Kent's bundle, Jame's fibers, Mahaim's fibers and its combination. Recent developments in the field of electrophysiology and surgical therapy became to support the concept of anomalous pathways and the possible determination of the re-entry circuit of paroxysmal tachycardia. Total 12 cases including 9 cases of classical W-P-W syndromes and 3 cases of L-G-L syndromes were followed with special interest of pre-excitation phenomenon and paroxysmal tachyarrhythmia at the National medical Center during the period of Jan. 1975 to Feb. 1979 and found to have paroxysmal tachyarrhythmia in 8 cases out of 12 cases. His bundle electrogram (HBE) and right atrial pacing were recoded in 2 cases of W-P-W type B to support the existance of an anomalous pathway. Treatment was instituted in accordance with recent advanced knowledge for the paroxysmal tachyarrhymia and pre-excitation and references were reviewed.
Atrioventricular Node ; Electrocardiography ; Electrophysiologic Techniques, Cardiac ; Electrophysiology ; Pre-Excitation Syndromes ; Tachycardia ; Tachycardia, Paroxysmal ; Tachycardia, Reciprocating ; Wolff-Parkinson-White Syndrome*

Permanent junctional reciprocating tachycardia (PJRT) is an infrequent form of reentrant supraventricular tachycardia. This tachycardia usually occurs in children and young adults and may be associated with tachycardiainduced cardiomyopathy. It is virtually incessant, at a rate ranging from 120 to 250 beats/minute. The characteristic electrocardiogram shows inverted P waves in the inferior leads with a long RP interval (RP greater than PR) during tachycardia. During tachycardia, the cardiac impulse conducts antegradely through the atrioventricular node and His-Purkinje system, returning retrogradely through the slowly conducting accessory pathway. The location of the accessory pathway is usually, but not always, near the ostium of the coronary sinus. Since the advent of radiofrequency catheter ablation (RFCA), several reports have emphasized the usefulness of RFCA for the treatment of PJRT. We report a case of PJRT in a 33-year-old male, successfully treated with RFCA.
Adult ; Atrioventricular Node ; Cardiomyopathies ; Catheter Ablation* ; Child ; Coronary Sinus ; Electrocardiography ; Humans ; Male ; Tachycardia ; Tachycardia, Reciprocating* ; Tachycardia, Supraventricular ; Young Adult

Atrial Fibrillation ; surgery ; Catheter Ablation ; methods ; Humans ; Male ; Middle Aged ; Recurrence ; Tachycardia, Reciprocating ; etiology ; surgery

Among patients with Wolff-Parkinson-White syndrome, atrioventricular reciprocating tachycardia (AVRT) and atrioventricular nodal reentrant tachycardia (AVNRT) can coexist in a single patient. Direct transition of both tachycardias is rare; however, it can occur after premature atrial or ventricular activity if the cycle lengths of the two tachycardias are similar. Furthermore, persistent atrial activation by an accessory pathway (AP) located outside of the AV node during ongoing AVNRT is also rare. This article describes a case of uncommon atrial activation by an AP during AVNRT and gradual transition of the two supraventricular tachycardias without any preceding atrial or ventricular activity in a patient with preexcitation syndrome.
Atrioventricular Node ; Humans ; Pre-Excitation Syndromes ; Tachycardia* ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Paroxysmal ; Tachycardia, Reciprocating ; Tachycardia, Supraventricular ; Wolff-Parkinson-White Syndrome*

Adult ; Female ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation ; adverse effects ; Humans ; Tachycardia, Reciprocating ; etiology ; Tachycardia, Ventricular ; etiology

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