Humans ; Wolff-Parkinson-White Syndrome/diagnosis* ; Electrocardiography ; Athletes

OBJECTIVETo observe whether there was difference between the head-chest leads electrocardiogram (HCECGs) and routine lead electrocardiogram (RLECGs) in the manifest accessory pathways in patients with Wolff-Parkinson-White syndrome.

METHODSHCECGs and RLECGs were recorded simultaneously in patients with Wolff-Parkinson-White syndrome, whose manifest accessory pathways had been confirmed by radiofrequency catheter ablation and intra-cardiac electrophysiology according to the same standard set beforehand. The diagnosis of pathways location was made by analysis of each HCECG and RLECG by two senior physicians in clinical electrophysiology. The diagnostic accuracy of the HCECGs and RLECGs was evaluated by the comparison with that of the intra-cardiac electrophysiology. The delta wave size was also compared between HCECGs and RLECGs.

RESULTSThe diagnostic accuracy in the manifest accessory pathways was 86.2% (50/58) in RLECGs, and 84.4% (49/58) in HCECGs in the 58 patients with Wolff-Parkinson-White syndrome, showing no significant difference between them (P > 0.05), but each delta wave in HCECG was more evident than that in RLECG.

CONCLUSIONHCECG and RLECG both have high diagnostic accuracy in the manifest accessory pathways in patients with Wolff-Parkinson-White syndrome.

OBJECTIVES: Accurate diagnosis of the mechanism and origin site of paroxysmal supraventricular tachycardia(PSVT) can be made using electrophysiologic study(EPS). Recently, radiofrequency catheter ablation technique has been introduced and widely used for the definitive treatment of various forms of PSVT, thereby precise determination of the mechanism of PSVT can be possible. It has been known that atrioventricular reentry tachycardia (AVRT) using concealed bypass tract is more frequent than atrioventricular nodal reentry tachycardia (AVNRT) in Korea. But it is not certain that those studies represent actual distribution of PSVT in Korea. This study was designed to determine the mechanism and clinical characteristics of PSVT in Korea. METHODS: We investigated 136patients in whom electrophysiolosic study was performed from October 1992 through October 1994 at the Chonnam National University Hospital, the only tertiary referral center of the Kwangju-Chonnam area of Korea. RESULTS: 1) The electrophysiologic mechanism of PSVT was AVNRT in 44patients(32.4%), WPW syndrome in 46(33.8%), AVRT using concealed bypass tract in 40(29.4%), sinoatrial nodal reentry tachycardia (SANRT) in 4(2.9%), and automatic atrial tachycardia(AAT) in 2(1.5%), ensuing that AVNRT is most common mechanism of PSVT with no preexcitation during sinus rhythm. 2) Male is more frequent than female in AVNRT, WPW syndrome, and AVRT, which was most prominent in WPW syndrome. 3) The first episode of symptom occured at the age of 34.9 +/- 17.3 years in AVNRT, 25.5 +/- 13.3 years in WPW and 26.3 +/- 15.0 years in AVRT(p<0.05). There was no significant difference in the duration of symptom. The tachycardia rate in WPW syndrome was 183.6 +/- 23.9 per minute and AVRT was 186.7 +/- 38.0 per minute, which were faster than that of AVNRT(161.7 +/- 28.6/min)(p<0.05). 4) There was no significant difference in the presenting symptoms and in the provocation factors between AVNRT and AVRT. CONCLUSION: AVNIlT is most common mechanism of PSVT with no preexcitation during sinus rhythm, developed at older age than WPW syndorme and AVRT, and had lower tachycardia rate than WPW syndrome and AVRT.
Catheter Ablation ; Diagnosis ; Female ; Humans ; Jeollanam-do ; Korea ; Male ; Tachycardia ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Sinoatrial Nodal Reentry ; Tachycardia, Supraventricular* ; Tertiary Care Centers ; Wolff-Parkinson-White Syndrome

BACKGROUND: In patients with acute posterior myocardial infarction, the standard 12 leads electrocardiogram is often nondiagnostic, but posterior chest leads(V7 to V9) are expecting to identify those patients with posterior involvement. And so the meaning of posterior chest leads for detecting posterior infarction needs to determine, especially in the elderly with often nondiagnostic routine electrocardiogram. METHODS: We studied eighty-four patients(aged 61+/-10 years, 61 men and 23 women) with acute myocardial infarction who had right coronary or left circumflex artery occlusion angiographically. All patients had technetium-99m pyrophosphate myocardial imaging and 2D echocardiographic imaging within 48 hours after admission to establish the diagnosis of acute posterior infarction. Patients were analyzed to determine on the diagnostic meaning of posterior chest leads and routine electrocardiogram in detecting posterior infarction. RESULTS: The overall sensitivity of posterior chest leads, especially of lead V9 in detecting acute posterior myocardial infarction were 86.3%(69/80) with ST-segment elevation and 87.5%(70/80) with the appearance of pathologic Q waves. The 4 patients with lateral infarction were no changes in post chest leads. Left bundle branch block, artificial pacemaker rhythm, WPW syndrome, old anterior myocardial infarction. hypertrophy of left ventricle with strain pattern, and small infarction were a obstacle to detect posterior involvement with posterior chest leads. There are no significant age-associated differences in elderly patients for detecting posterior involvement with posterior chest leads. CONCLUSION: Posterior chest leads(V7-9), especially lead V9 are a very sensitive and useful tool for diagnosis of posterior infarction, with no age associated differences.
Aged ; Arteries ; Bundle-Branch Block ; Diagnosis* ; Echocardiography ; Electrocardiography* ; Heart Ventricles ; Humans ; Hypertrophy ; Infarction ; Male ; Myocardial Infarction* ; Pacemaker, Artificial ; Thorax* ; Wolff-Parkinson-White Syndrome

BACKGROUND: Wolff-Parkinson-White syndrome(WPW syndrome) is well known and somtimes causes life-threatening arrhythmias.To date,the clinical and electrophysiologic charicteristics of patients with WPW syndrome in Korea has not been available,though results of catheter ablation treatment for atrioventricular reentrant tachycardia(AVRT) including WPW syndrome were reported. METHOD: Clinical and electrocardiographic(ECG) characteristics and results of electrophysiologic study of consecutive 400 patients with WPW syndrome who underwent electrophsiologic study between December 1986 and September 1995 were analyzed. RESULTS: Mean age of the patients was 35 years and male patients were more common(262male patients,65.5%).Mean duration and frequency of palpitation episodes were 8.1 years and 4.2 times per month,respectively.Thirty six patients(9.0%) experienced syncopal episodes and the half of them were associated with atrial fibrillation.Two cases of aborted sudden cardiac death were associated with atrial fibrillation.Twenty four cases of congenital heart diseases and 13 cases of acquired heart diseases were found.The most commonly associated cardiac disease was Ebstein's anomaly(8 cases,2,0%).Clinically,368 patients(92,0%) had ECG-documented tachycardias and 46 patients had two or more types of tachycardia.Orthodromic AVRT was the most common tachcardia (227 patients including 44 cases with coexisting atrial fibrillation).Atrial fibrillation was documented in 115 patients(31.1%) and antidromic AVRT in 23 patients(6.2%).Patients with antidromic AVRT were more likely to have multiple accessory pathways compared to those with orthodromic AVRT (30.4% versus 4.3%).On electrophysiologic study,the most commonly inducible tachcardia was also orthodromic AVRT (334/389 cases,89.8%).Antidromic AVRT was induced in 23 cases(6.0%).Atrial fibrillation was present in 104 patients(27.2%),especially in those with clinically documented atrial fibrillation(71.3% vs 12.3%).In 17 patients without inducible tachycardias,ventriculoatrial conduction was absent or had long effective refractory period.Finally,396 patients(99.0%) had clinically documented or inducible tachycardias.Eight patients with Ebstein's anomaly had right-sided accessory pathway(87.5%)exept one case.Twenty four patients had secondary accessory pathway.The most common site of accessory pathway including secondary accessory pathway was left free wall(204 cases,48.1%).Other accessory pathways were found at right free wall(123 cases,29.0%),posteroseptal(54 cases,17.5%)and anteroseptal site(15 cases,3.5%)in order. CONCLUSIONS: The clinical and electrophysiologic characteristics of patients in this series were similar with those of previous reports of other countries.Because certain types of tachyarrhythmia were associated with characteristic electrophysiologic findings such as the relationships between antidromic AVRT and presence of secondary accessory pathways or clinical atrial fibrillation and higher occurrence rate of atrial fibrillation during electrophysiologic study,it is important to document clinical tachyarrhythmias with ECG.And electrophysiologic study can have important clinical implications in diagnosis and especially in curative treatment.
Atrial Fibrillation ; Catheter Ablation ; Death, Sudden, Cardiac ; Diagnosis ; Ebstein Anomaly ; Heart Diseases ; Humans ; Korea ; Male ; Syncope ; Tachycardia ; Wolff-Parkinson-White Syndrome*

BACKGROUND: Coronary sinus catheterization is important in electrophysiological studies. However the mor-phologic feature of the coronary sinus and its significance in patients with supraventricular tachycardia (SVT) have not been determined. During diagnostic electrophysiological studies, coronary sinus catheterization was easier in patients with atrioventricular nodal reentry tachycardia (AVNRT) than in patients with atrioventricular reentry tachycardia (AVRT). Therefore, we studied coronary sinus morphology in patients with SVT and compared AVNRT and AVRT patients. METHODS: The size and shape of the coronary sinus were measured in 13 patients who underwent retrograde coronary sinus venogram during electrophysiologic study between May and June 1996. The diagnosis was 7 cases of AVNRT, 2 of Wolff-Parkinson-White syndrome and 4 of concealed bypass tracts (mean age, 40 years : male vs female, 1 : 1.2). RESULTS: The mean coronary sinus ostial diameter was 10.4+/-2.0 mm:for AVNRT, it was 11.4+/-2.2 mm, and for AVRT it was 9.3+/-1.0 mm in left anterior oblique projection (p=0.031). The mean coronary sinus-to-spine angle was 82.6+/-17.4degrees : AVNRT 95.4+/-24.4degrees and AVRT 67.7+/-15.2degrees in anterior posterior projection (p=0.035). CONCLUSION: The coronary sinus ostial diameter of AVNRT patients was significantly larger than that of AVRT patients. This finding may have important implications for arrythmia pathogenesis in such patients.
Arrhythmias, Cardiac ; Catheterization ; Catheters ; Coronary Sinus* ; Diagnosis ; Female ; Humans ; Male ; Tachycardia ; Tachycardia, Atrioventricular Nodal Reentry ; Tachycardia, Supraventricular* ; Wolff-Parkinson-White Syndrome

Mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome presents with various clinical features, including seizures, stroke-like episodes, encephalopathy, myopathy, cardiac involvement, and diabetes. However, due to its clinical heterogeneity, the diagnosis of MELAS syndrome is complex and difficult. The present report describes an 18-year-old male who was diagnosed with MELAS syndrome following the onset of type 1 diabetes. The patient had suffered from ataxia, mental retardation, and recurrent headaches for several years; following hospitalization for loss of consciousness, he was treated for cerebellar atrophy and Wolf-Parkinson-White (WPW) syndrome. Although the patient had no history of lactic acidosis, the recent onset of type 1 diabetes and his medical history of encephalopathy and WPW syndrome suggested MELAS syndrome. The diagnosis of MELAS syndrome was confirmed by molecular genetic testing, which revealed a point mutation (A3243G) in the patient's mitochondrial DNA.
Acidosis, Lactic ; Adolescent ; Ataxia ; Atrophy ; Diabetes Mellitus, Type 1* ; Diagnosis ; DNA, Mitochondrial ; Headache ; Hospitalization ; Humans ; Intellectual Disability ; Male ; MELAS Syndrome* ; Molecular Biology ; Muscular Diseases ; Point Mutation ; Population Characteristics ; Seizures ; Unconsciousness ; Wolff-Parkinson-White Syndrome

PURPOSE: Isolated noncompaction of the ventricular myocardium(INVM) can present as heart failure or arrhythmias in a child. It is a rare disorder, characterized by prominent trabecular meshwork and deep intertrabecular recesses. We still know little about the diagnosis, symptoms, and clinical outcomes of INVM. METHODS: We included in our study 6 patients who showed ventricular noncompaction on echocardiography. Patients were diagnosed as INVM were excessively prominent trabeculations with deep intertrabecular recesses were found on echocardiography. Patients who had other complex heart lesions such as pulmonary atresia with intact ventricular septum in addition to ventricular noncompaction, were excluded. RESULTS: Age at presentation ranged from 1 day 7 years, with follow up being as long as 6 years. Symptoms at initial presentation were heart murmur, paroxysmal supraventricular tachycardia, cyanosis, feeding intolerance, ventricular tachycardia, and cardiomegaly at fetal screening. Prominent trabeculations and intertrabecular recesses were observed at left ventricular apex in all six patients. All patients were alive at last follow-up. One patient showed WPW syndrome on electrocardiography. Echocardiography revealed decreased systolic function in 4 patients, and decreased systolic and diastolic function in 1 patient. One patient is currently asymptomatic. CONCLUSION: Six patients were diagnosed with INVM with various symptoms at initial presentation. Echocardiography is the most important tool in the diagnosis of INVM due to its morphological characteristics. INVM can rarely be the cause of long term systolic dysfunction, and early detection by echocardiographic screening may be beneficial.
Arrhythmias, Cardiac ; Cardiomegaly ; Child ; Cyanosis ; Diagnosis ; Echocardiography ; Electrocardiography ; Follow-Up Studies ; Heart ; Heart Failure ; Heart Murmurs ; Humans ; Isolated Noncompaction of the Ventricular Myocardium* ; Mass Screening ; Pulmonary Atresia ; Tachycardia, Supraventricular ; Tachycardia, Ventricular ; Trabecular Meshwork ; Ventricular Septum ; Wolff-Parkinson-White Syndrome

OBJECTIVE: To review the diagnosis, treatment, and perinatal outcome of fetal tachyarrhythmias. METHODS: We reviewed the medical records of pregnant women diagnosed with fetal tachyarrhythmia at Asan Medical Center from June 1997 to December 2004. Tachyarrhythmias were classified as either supraventricular tachycardia (SVT) or atrial flutter (AF), and the intrauterine management and long-term outcomes of the infants were analyzed. RESULTS: There were three cases of SVT and four cases of AF. Fetal hydrops was noted in 4 of 7 fetuses and there were no cardiac anomalies. All of them were treated in utero with antiarrhythmic agents including digoxin and flecainide. During antiarrhythmic therapy, sinus rhythm was achieved in 100% of them and the survival rate was 100%. Two infants diagnosed prenatally with SVT developed Wolff-Parkinson-White syndrome after birth. One of them developed paroxysmal SVT but after adenosine treatment she needed no treatment. One fetus with AF was diagnosed with an atrial ectopic tachyarrhythmia postnatally which needed medication for one year and resulted in normal sinus rhythm. At the time of this study, all of them showed normal development without neurological morbidity. CONCLUSION: Fetal tachyarrhythmias diagnosed prenatally can be effectively treated with antiarrhythmic drugs in utero or postnatally even if they had hydropic feature. So they must be referred to a tertiary care center for appropriate counseling and management. We recommend that every SVT or AF should be treated in utero regardless of the presence of hydrops.
Adenosine ; Anti-Arrhythmia Agents ; Atrial Flutter ; Chungcheongnam-do ; Counseling ; Diagnosis* ; Digoxin ; Edema ; Female ; Fetus ; Flecainide ; Humans ; Hydrops Fetalis ; Infant ; Medical Records ; Parturition ; Pregnant Women ; Survival Rate ; Tachycardia ; Tachycardia, Supraventricular ; Tertiary Care Centers ; Wolff-Parkinson-White Syndrome

PURPOSE: Isolated noncompaction of the ventricular myocardium(INVM) is one of the unclassified cardiomyopathies that is characterized by numerous, excessively prominent trabeculations, and deep intertrabecular recesses. We performed this study to evaluate the clinical features of INVM in children. METHODS: The medical records of 10 patients with INVM were reviewed. We analyzed the clinical manifestations, hemodynamics, pattern of inheritance, and long-term prognosis of INVM in children. RESULTS: Age at diagnosis was 45+/-53 months(1 day-14 years) with follow-up lasting as long as 78 months. Most INVM was asymptomatic on diagnosis. Associated cardiac anomalies were noted in six patients(ventricualr or atrial septal defect, patent ductus arteriosus with mitral valve prolapse, or mitral valve cleft). Depressed or flat changes of T wave in lead II, III and aVF were observed on electrocardiography. Various arrhythmia including WPW syndrome with paroxysmal, supraventricular tachycardia, third-degree atrioventricular block, and familial sick sinus node dysfuction were observed. The degree of trabeculation in INVM was significantly prominent from level of mitral valve to apex compared to age-matched control. Familial recurrences were noted in two patients. The systolic function of the left ventricle was decreased in 20% of patients during the follow-up period, but systemic embolism or ventricular tachycardia was not observed. CONCLUSIONS: INVM is not a rare disorder. The cardiac function may be deteriorated in children as well as adults during long-term follow up. Thus early diagnosis and long-term follow-up must be done. So, the nation-wide multicenter clinical study would be mandatory to evaluate the incidence, long-term prognosis, and establishment of objective diagnostic criteria of INVM.
Adult ; Arrhythmias, Cardiac ; Atrioventricular Block ; Cardiomyopathies ; Child ; Diagnosis ; Ductus Arteriosus, Patent ; Early Diagnosis ; Electrocardiography ; Embolism ; Follow-Up Studies ; Heart Septal Defects, Atrial ; Heart Ventricles ; Hemodynamics ; Humans ; Incidence ; Isolated Noncompaction of the Ventricular Myocardium* ; Medical Records ; Mitral Valve ; Mitral Valve Prolapse ; Prognosis ; Recurrence ; Sinoatrial Node ; Tachycardia, Supraventricular ; Tachycardia, Ventricular ; Wills ; Wolff-Parkinson-White Syndrome