Catheter ablation of the left free-wall accessory pathways (APs) is normally performed by the retrograde transaortic approach via a femoral artery or the transseptal approach. Here we report a case of an overt left free-wall AP, which was successfully ablated with a retrograde transaortic approach via the radial artery without any vascular complications. The patient has remained free of any symptoms or pre-excitation observed on the ECG during a 10-month post- ablation follow-up.
Adult ; Catheter Ablation/*methods ; Electrocardiography ; Humans ; Male ; Tachycardia, Supraventricular/complications/physiopathology/*therapy ; Treatment Outcome ; Wolff-Parkinson-White Syndrome/complications/pathology

Adult ; Cesarean Section ; methods ; Female ; Fluid Therapy ; Heart Diseases ; complications ; Humans ; Pregnancy ; Wolff-Parkinson-White Syndrome ; complications ; therapy

We report electroversion in treatment of atrial fibrillation (AF) and atrioventricular nodal reentry tachycardia (AVNRT) in a patient with Wolff-Parkinson-White syndrome and cervical spinal cord injury. At first, the patient sustained respiratory failure and weak cough reflex, thereafter repeated bronchoscopy was used to aspirate the sputum as well as control the pneumonia, which resulted in arrhythmia (AF and AVNRT). Two doses of intravenous amiodarone failed to correct the arrhythmia. After restoration of sinus rhythm by electroversion, he was successfully weaned from mechanical ventilation and discharged from the intensive care unit without recurrent arrhythmia.
Atrial Fibrillation ; complications ; therapy ; Bronchoscopy ; Cervical Vertebrae ; injuries ; Electric Countershock ; Electrocardiography ; Humans ; Male ; Middle Aged ; Respiration, Artificial ; Spinal Cord Injuries ; complications ; Wolff-Parkinson-White Syndrome ; complications

This study was designed to investigate the clinical and electrophysiologic characteristics of WPW syndromes in Korea. A total of 400 symptomatic WPW syndrome patients were consecutively recruited. The most common documented symptomatic tachyarrhythmia was orthodromic atrioventricar reentrant tachycardia (75.3%), followed by atrial fibrillation (31.3%), and antidromic atrioventricular reentrant tachycardia (6.2%). There was a higher incidence of multiple bypass tract in patients with antidromic tachycardia than in those with orthodromic tachycardia (30.4 vs 4.3%, P < 0.001). The inducibility of tachyarrhythmia with electrophysiologic study in this study population was 95.8%. The most frequent location of the accessory pathway was the left free wall (48.0%), followed by the right free wall (29.1%), posterior septum (17.5%) and anterior septum (3.5%). These results indicated that 1) clinical and electrophysiological characteristics of Korean patients with WPW syndrome were similar to those of western countries and 2) the electrophysiologic study was important in the evaluation of patients with WPW syndrome.
Adolescence ; Adult ; Atrial Fibrillation/physiopathology ; Atrial Fibrillation/complications ; Child ; Child, Preschool ; Electrocardiography ; Electrophysiology ; Female ; Human ; Korea ; Male ; Middle Age ; Tachycardia/physiopathology ; Tachycardia/complications ; Tachycardia, Atrioventricular Nodal Reentry/physiopathology ; Tachycardia, Atrioventricular Nodal Reentry/complications ; Wolff-Parkinson-White Syndrome/physiopathology* ; Wolff-Parkinson-White Syndrome/complications

OBJECTIVETo analyze the adverse effects of type B ventricular pre-excitation on ventricular wall motion and left ventricular function and its clinical characteristic.

METHODThe clinical, electrophysiological and echocardiographic characteristics of the 9 cases with type B ventricular pre-excitation before and after ablation seen between March 2011 and March 2013 were analyzed. The patients aged from 3 to 16 years. Five of them were female.

RESULTDyschronous left ventricular contraction was demonstrated by M-Mode echocardiography in all of the cases. The basal segments of the interventricular septum turned thin and moved in a manner similar to that of an aneurysm, with typical bulging during end-systole, which was observed in six cases. All patients received successful RFCAs. The locations of the accessory pathways (APs) were the right-sided anteroseptum (n = 2) and the free wall (n = 7). Their physical activities and growth improved greatly in the four cases with coexisting dilated cardiomyopathy (DCM). The echocardiographic data demonstrated that their LV contraction recovered to synchrony shortly after the ablation, LVEF recovered to normal and LVED decreased to almost normal gradually during the follow-up.

CONCLUSIONOvert right-sided APs may have adverse effects on ventricular wall motion and left ventricular function. They can even result in DCM. Dyssynchronous ventricular contraction induced by right-sided overt accessory pathway may be the vital mechanism. Such kinds of cases are indication for ablation with good prognosis.

Adolescent ; Cardiomyopathy, Dilated ; diagnostic imaging ; etiology ; physiopathology ; Catheter Ablation ; Child ; Child, Preschool ; Echocardiography ; Female ; Heart Ventricles ; physiopathology ; Humans ; Male ; Myocardial Contraction ; Ventricular Dysfunction, Left ; diagnostic imaging ; etiology ; physiopathology ; Wolff-Parkinson-White Syndrome ; complications ; physiopathology