RESUMO
BACKGROUND: Although cryoablation (CA) of septally located accessory pathways (APs) is an established treatment for Wolff-Parkinson-White Syndrome, its major limitation is the lack of data regarding long-term follow-up (FU). The present study sought to investigate long-term outcomes of a specific CA protocol targeting para-Hisian (P-H) and mid-septal (M-S) APs. METHODS: Twenty-six patients who previously underwent CA of PH or MS APs from 2004 to 2014, were prospectively considered to receive a FU during 2021. All subjects received an outpatient control visit, performing an exercise stress test and a 24-h ECG Holter monitoring. RESULTS: Acute success was achieved in 22 patients (85%). One case of recurrence was reported at short-term FU. Long-term FU, performed after a mean time of 150±37 months, did not show ventricular preexcitation recurrences, with a success rate of 81%, and without late adverse events. Symptoms reduction (12% vs. 96%, P<.001) and lower rates of antiarrhythmic drug use (12% vs. 62%, P<.001) were observed at long term-FU with respect to baseline. This clinical outcome was detected also among patients who underwent unsuccessful CA at baseline. CONCLUSIONS: Our CA protocol confirmed remarkable safety and efficacy throughout a long-term FU. Significant clinical improvement in terms of antiarrhythmic therapy discontinuation and symptoms reduction was also shown among patients who experienced acute failure of CA.
Assuntos
Feixe Acessório Atrioventricular , Criocirurgia , Síndrome de Wolff-Parkinson-White , Humanos , Criocirurgia/efeitos adversos , Criocirurgia/métodos , Resultado do Tratamento , Feixe Acessório Atrioventricular/cirurgia , Feixe Acessório Atrioventricular/etiologia , Síndrome de Wolff-Parkinson-White/cirurgia , Síndrome de Wolff-Parkinson-White/etiologia , AntiarrítmicosRESUMO
Wolff-Parkinson-White (WPW) syndrome causes paroxysmal supraventricular tachycardia in which short PR intervals and delta waves are seen in electrocardiography, which may cause sudden cardiac death. A 19-year female presented with increasing episodes of wide and narrow QRS complex tachycardia for the past 5 years. She had tricuspid atresia and Fontan Bjork operation in her past history. She was then diagnosed with narrow QRS complex tachycardia; and WPW syndrome was discovered when she returned to sinus rhythm. Ablation was performed from the coronary sinus ostium region via the left subclavian vein. Fontan Bjork procedure leading to accessory connections stemming from the surgery in the atrio-infundibular anastomosis may be one reason for WPW syndrome. In this case, since the ablation area was close to the Fontan anastomotic line, it could not be determined clearly whether WPW syndrome was secondary to Fontan anastomosis or it was congenital occult WPW syndrome, which became overt following Fontan surgery.
Assuntos
Ablação por Cateter , Seio Coronário , Técnica de Fontan/efeitos adversos , Atresia Tricúspide/cirurgia , Síndrome de Wolff-Parkinson-White/etiologia , Síndrome de Wolff-Parkinson-White/cirurgia , Feminino , Humanos , Síndrome de Wolff-Parkinson-White/diagnóstico , Adulto JovemRESUMO
A 14-year-old patient was diagnosed with hypertrophic cardiomyopathy associated with Wolff-Parkinson-White syndrome. The two-dimensional speckle tracking strain method showed normal left ventricular local contraction, but the peak systolic longitudinal strain of the right ventricular (RV) anterior wall was earlier than that of the septal wall. As expected, the location of the accessory pathway was at the RV anterior wall. The patient's RV local contraction was normalized by successful radiofrequency application.
Assuntos
Cardiomiopatia Hipertrófica/complicações , Ablação por Cateter/métodos , Diagnóstico por Imagem/métodos , Ecocardiografia/métodos , Sistema de Condução Cardíaco/fisiopatologia , Cirurgia Assistida por Computador/métodos , Síndrome de Wolff-Parkinson-White/diagnóstico , Adolescente , Cardiomiopatia Hipertrófica/diagnóstico , Eletrocardiografia , Fluoroscopia/métodos , Seguimentos , Sistema de Condução Cardíaco/cirurgia , Humanos , Masculino , Fatores de Tempo , Síndrome de Wolff-Parkinson-White/etiologia , Síndrome de Wolff-Parkinson-White/cirurgiaAssuntos
Ecocardiografia/métodos , Eletrocardiografia Ambulatorial/métodos , Doença de Depósito de Glicogênio Tipo IIb , Hipertrofia Ventricular Esquerda/patologia , Proteína 2 de Membrana Associada ao Lisossomo/genética , Síndrome de Wolff-Parkinson-White/etiologia , Biópsia , Testes Genéticos , Doença de Depósito de Glicogênio Tipo IIb/complicações , Doença de Depósito de Glicogênio Tipo IIb/diagnóstico , Doença de Depósito de Glicogênio Tipo IIb/genética , Doença de Depósito de Glicogênio Tipo IIb/fisiopatologia , Humanos , Hipertrofia Ventricular Esquerda/etiologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Imageamento por Ressonância Magnética , Masculino , Monitorização Fisiológica , Prognóstico , Taquicardia/diagnóstico , Taquicardia/etiologia , Síndrome de Wolff-Parkinson-White/diagnóstico , Adulto JovemRESUMO
Due to the growing awareness of exercise-related arrhythmias and improved sensitivity of diagnostic modalities, physicians are increasingly faced with choices that may have life-changing impact for the athlete. This article surveys recent research and expert opinion addressing benign and pathogenic cardiac changes underlying arrhythmias in athletes.
Assuntos
Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiologia , Atletas , Coração/fisiopatologia , Miocárdio/patologia , Arritmias Cardíacas/metabolismo , Displasia Arritmogênica Ventricular Direita/diagnóstico , Displasia Arritmogênica Ventricular Direita/etiologia , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/etiologia , Flutter Atrial/diagnóstico , Flutter Atrial/etiologia , Síndrome de Brugada/diagnóstico , Síndrome de Brugada/etiologia , Cardiomegalia/diagnóstico , Cardiomegalia/etiologia , Catecolaminas/metabolismo , Commotio Cordis/diagnóstico , Commotio Cordis/etiologia , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico , Morte Súbita Cardíaca/etiologia , Humanos , Síndrome do QT Longo/diagnóstico , Síndrome do QT Longo/etiologia , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/etiologia , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/etiologia , Síndrome de Wolff-Parkinson-White/diagnóstico , Síndrome de Wolff-Parkinson-White/etiologiaAssuntos
Arritmias Cardíacas/diagnóstico , Ponte de Artéria Coronária , Reestenose Coronária/diagnóstico , Eletrocardiografia Ambulatorial , Oclusão de Enxerto Vascular/diagnóstico , Infarto do Miocárdio/cirurgia , Complicações Pós-Operatórias/diagnóstico , Idoso , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/terapia , Bradicardia/diagnóstico , Bradicardia/etiologia , Bradicardia/terapia , Terapia Combinada , Reestenose Coronária/terapia , Desfibriladores Implantáveis , Diagnóstico Diferencial , Oclusão de Enxerto Vascular/terapia , Humanos , Masculino , Marca-Passo Artificial , Equipe de Assistência ao Paciente , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Processamento de Sinais Assistido por Computador , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia , Taquicardia Ventricular/terapia , Síndrome de Wolff-Parkinson-White/diagnóstico , Síndrome de Wolff-Parkinson-White/etiologia , Síndrome de Wolff-Parkinson-White/terapiaRESUMO
OBJECTIVES: There are reports associating an increased incidence of Wolff-Parkinson-White syndrome with tricuspid atresia. Here we report on electrophysiologic studies in patients with tricuspid atresia and Wolff-Parkinson-White syndrome after the Fontan operation. In these patients the atrial arrhythmia often seen in patients undergoing the Fontan operation triggered atrioventricular re-entrant tachycardia or caused life-threatening arrhythmias. METHODS: Five patients with tricuspid atresia after palliation with a modified Fontan operation (atrioinfundibular connections) and Wolff-Parkinson-White syndrome are presented. RESULTS: Four of these patients had symptomatic paroxysmal orthodromic atrioventricular re-entrant tachycardia and a history of syncope; one of them additionally had atrial flutter with 2:1 conduction to the ventricle. A fifth patient presented with a life-threatening broad-complex tachycardia. In electrophysiologic studies an accessory pathway was localized in the right septal area in 3 patients. In 2 patients the accessory atrioventricular pathways were created by means of surgical intervention, connecting the right atrial appendage to the right ventricular outflow tract. All patients could be managed successfully by means of catheter ablation. CONCLUSIONS: In patients with tricuspid atresia, there are congenital and surgically acquired accessory pathways responsible for the increased rate of Wolff-Parkinson-White syndrome. Both types of accessory pathways can and should be treated by means of catheter ablation because atrial arrhythmia often seen in patients undergoing the Fontan operation can trigger atrioventricular re-entrant tachycardia or cause life-threatening tachycardia. Congenital accessory pathways should be excluded carefully before surgical intervention for total cavopulmonary anastomosis in patients with tricuspid atresia.
Assuntos
Técnicas Eletrofisiológicas Cardíacas , Sistema de Condução Cardíaco/anormalidades , Atresia Tricúspide/complicações , Síndrome de Wolff-Parkinson-White/etiologia , Adolescente , Adulto , Ablação por Cateter , Eletrocardiografia , Feminino , Técnica de Fontan , Humanos , Masculino , Taquicardia por Reentrada no Nó Atrioventricular/etiologia , Síndrome de Wolff-Parkinson-White/fisiopatologiaRESUMO
Ebstein's anomaly is a common congenital abnormality in the Wolff-Parkinson white syndrome (WPW). The term WPW is applied to patients with both preexcitation on ECG and paroxysmal tachycardias. In this case review, we describe a female with a history of intermittent palpitations who presented in the postpartum period with WPW. Subsequent testing revealed an underlying Ebstein's anomaly. In the United States, heart disease is responsible for 10% of maternal deaths. Although pregnancy is well known to exacerbate symptoms in patients with WPW, postpartum exacerbation has not been clearly described. This unusual case suggests that monitoring beyond the peurperium would be advisable in patients at risk to develop malignant tachyarrhythmias.
Assuntos
Anomalia de Ebstein/diagnóstico , Período Pós-Parto , Síndrome de Wolff-Parkinson-White/diagnóstico , Adulto , Diagnóstico Diferencial , Anomalia de Ebstein/complicações , Eletrocardiografia , Feminino , Humanos , Taquicardia Supraventricular/diagnóstico , Síndrome de Wolff-Parkinson-White/etiologiaAssuntos
Morte Súbita Cardíaca/prevenção & controle , Algoritmos , Estenose da Valva Aórtica/etiologia , Estenose da Valva Aórtica/terapia , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/terapia , Displasia Arritmogênica Ventricular Direita/etiologia , Displasia Arritmogênica Ventricular Direita/terapia , Cardiomiopatia Dilatada/etiologia , Cardiomiopatia Dilatada/terapia , Cardiomiopatia Hipertrófica/etiologia , Cardiomiopatia Hipertrófica/terapia , Morte Súbita Cardíaca/etiologia , Insuficiência Cardíaca/complicações , Humanos , Síndrome do QT Longo/etiologia , Síndrome do QT Longo/terapia , Prolapso da Valva Mitral/etiologia , Prolapso da Valva Mitral/terapia , Infarto do Miocárdio/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Ressuscitação , Fatores de Risco , Torsades de Pointes/induzido quimicamente , Torsades de Pointes/mortalidade , Síndrome de Wolff-Parkinson-White/etiologia , Síndrome de Wolff-Parkinson-White/terapiaRESUMO
Antes del inicio del siglo XX la radiofrecuencia se usaba ya para coagular tejidos. A mitad de los ochenta se comenzó a utilizar para ablación intracavitaria del corazón. Consiste en una forma de corriente alterna que comprende el espectro de 100 kHz hasta las microondas. La generación de calor se produce en el tejido debido a la emisión rápida de iones al paso de la corriente a través de las células. Las lesiones generadas son áreas de necrosis pequeñas y limitadas. La técnica está indicada para el tratamiento del síndrome de Wolff-Parkinson-White y de taquicardias supraventriculares. Se suele utilizar una descarga entre 20 a 40 W, por 10 a 30 segundos, con un éxito clínico superior a 90 por ciento. Las complicaciones consisten en bloqueo auriculoventricular, tamponade car-diaco, neumotórax, complicaciones vasculares, embolismo pulmonar y paro cardiaco. No se han hecho estudios in vivo de correlación entre el área de necrosis y los parámetros de potencia y tiempo.
Assuntos
Arritmias Cardíacas , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Pneumotórax/etiologia , Síndrome de Wolff-Parkinson-White/etiologiaRESUMO
Tuberous sclerosis is an autosomal-dominant disease with involvement of several organs, the heart included. The cardiac anomaly most frequently found is the rhabdomyoma association. However, WPW association has also been encountered more common than usual. In the majority of the published related-series, infant or adolescent patients are described. We report the case of a 68-year-old patient with tuberous sclerosis whose first cardiac manifestation was a pre-excited atrial fibrillation. This association is reviewed and the consideration of accessory pathways is highlighted as the first mechanism to take into account when arrhythmias are present in these patients even in adult age.
Assuntos
Fibrilação Atrial/etiologia , Esclerose Tuberosa/complicações , Síndrome de Wolff-Parkinson-White/etiologia , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Terapia Combinada , Eletrocardiografia , Humanos , Masculino , Síndrome de Wolff-Parkinson-White/diagnóstico , Síndrome de Wolff-Parkinson-White/terapiaRESUMO
A case of a young male with WPW syndrome due to a left posteroseptal tract associated with a persistent left superior vena cava is described. After unsuccessful ablation attempts with a number of different approaches at conventional target sites, the accessory connection was successfully ablated within the coronary sinus. This was achieved only when the ablation catheter was introduced through the persistent left superior vena cava.
Assuntos
Ablação por Cateter/métodos , Defeitos dos Septos Cardíacos/cirurgia , Veia Cava Superior/anormalidades , Adulto , Eletrocardiografia , Defeitos dos Septos Cardíacos/complicações , Humanos , Masculino , Reoperação , Síndrome de Wolff-Parkinson-White/etiologiaRESUMO
Despite the recent advent of and the successful results from catheter ablation, pharmacological therapy is still used by most clinicians as the first line therapy in patients with regular supraventricular tachycardias. Before prescribing an antiarrhythmic agent, documentation of the arrhythmia using a 12-lead electrocardiogram (ECG) is necessary to identify the type of tachycardia. The ECG diagnosis is based on the presence and polarity of the P wave, the P to QRS relationship, the presence of QRS alternation and the effect of bundle branch block on tachycardia rate. Most regular supraventricular tachycardias use the atrioventricular node either passively, as in atrial tachycardias or flutter, or actively, as paroxysmal junctional tachycardias. The Sicilian Gambit approach attempted to introduce some rationale in the choice of an antiarrhythmic agent, taking into account tachycardia mechanism, by defining the critical components of the tachycardia and the vulnerable parameter, i.e. the component that may readily be affected by an appropriate antiarrhythmic agent. For this approach, an electrophysiological study is particularly useful. The most common regular paroxysmal supraventricular tachycardias include atrioventricular nodal re-entrant tachycardias and atrioventricular re-entrant tachycardias which use an overt or concealed accessory atrioventricular connection (Kent bundle) or atriofascicular connection (Mahaim). For acute termination of paroxysmal junctional tachycardia, intravenous adenosine is the drug of choice. For the prevention of the tachycardia attacks in atrioventricular nodal re-entrant tachycardia, the agents with a depressive effect on the antegrade slow pathway, such as calcium channel blockers or beta-blockers, are likely to be effective. If they fail, sodium channel blockers (propafenone or flecainide) may be indicated. In tachycardias involving accessory connections, agents that affect fast channel dependent tissue (propafenone, flecainide, cibenzoline, disopyramide or hydroquinidine) are effective. Potassium current blockers, such as sotalol or amiodarone, represent an alternative therapy. In atrial tachycardias, the use of propafenone, flecainide or sotalol constitute a logical choice. In drug-resistant cases, amiodarone is the most potent agent. Radiofrequency ablation of the slow atrioventricular nodal pathway, of an accessory connection or of an atrial focus, is indicated in drug-resistant or drug-intolerant patients and is increasingly offered as an alternative therapy.
Assuntos
Antiarrítmicos/uso terapêutico , Taquicardia Supraventricular/tratamento farmacológico , Algoritmos , Antiarrítmicos/efeitos adversos , Diagnóstico Diferencial , Eletrocardiografia/efeitos dos fármacos , Humanos , Taquicardia Supraventricular/etiologia , Resultado do Tratamento , Síndrome de Wolff-Parkinson-White/tratamento farmacológico , Síndrome de Wolff-Parkinson-White/etiologiaAssuntos
Ablação por Cateter/métodos , Síndrome de Wolff-Parkinson-White/cirurgia , Síndrome de Wolff-Parkinson-White/terapia , Ablação por Cateter/economia , Ablação por Cateter/história , Ablação por Cateter/tendências , Eletrofisiologia/métodos , Sistema de Condução Cardíaco/fisiopatologia , Sistema de Condução Cardíaco/cirurgia , História do Século XX , Humanos , Síndrome de Wolff-Parkinson-White/etiologia , Síndrome de Wolff-Parkinson-White/históriaRESUMO
A 7-month-old girl weighing 5.3 kg, presented with atrial septal defect (ASD) and paroximal supraventricular tachycardia (PSVT). The preoperative electrophysiological study could not be performed because of the severe heart failure. On suspicion of a concealed Wolff-Parkinson-White (WPW) syndrome, whose accessory pathways conduct in the retrograde direction only, the operation was performed. The intraoperative epicardial and endocardial mappings revealed the presence of a left-posterior retrograde accessory pathway. This accessory pathway was successfully ablated by a cryoablation using transseptal superior approach. The postoperative course was uneventful without a permanent heart block. We report a successful surgical repair for an infant with concealed WPW syndrome, who revealed severe heart failure because of PSVT and ASD.
Assuntos
Comunicação Interatrial/complicações , Síndrome de Wolff-Parkinson-White/cirurgia , Eletrocardiografia , Feminino , Humanos , Lactente , Taquicardia Supraventricular/complicações , Síndrome de Wolff-Parkinson-White/etiologia , Síndrome de Wolff-Parkinson-White/fisiopatologiaRESUMO
Ebstein"s anomaly is the most common congenital heart disease associated with the Wolf-Parkinson-White syndrome. Between November 1973 and March 1993, we surgically treated 42 patients with Wolff-Parkinson-White syndrome and Ebstein's anomaly. The patient's ages ranged from 5 months to 59 years (mean 35.3 +/- 14.0 years). There were a total of 52 accessory pathways, 48 of which were located in the right (65%) or posteroseptal (29%) area. A left-sided accessory pathway was seen in only two patients (3.8%). Division of all right-sided accessory pathways was done during normothermic cardiopulmonary bypass with the heart beating; cryocoagulation was applied together with scalpel dissection of the atrioventricular groove. Division of the left-sided accessory pathways was done with the use cold potassium cardioplegic arrest. Thirty-five of these patients underwent tricuspid valve operation for Ebstein's anomaly and 11 of them underwent tricuspid valve replacement with a bioprosthesis. All 52 accessory pathways were successfully divided, although two patients required reoperation because of tachycardia caused by accessory pathways in different positions. Three hospital deaths (7.1%) occurred. There were no late deaths during the follow-up period (mean 94.3 +/- 52.4 months), but two patients required repeat tricuspid operation because of progression of the tricuspid regurgitation. Because no repeat operations were required during long-term follow-up patients who underwent valve repair or valve replacement, correction should be indicated in some patients.
Assuntos
Bioprótese , Criocirurgia , Anomalia de Ebstein/complicações , Anomalia de Ebstein/cirurgia , Próteses Valvulares Cardíacas , Síndrome de Wolff-Parkinson-White/etiologia , Síndrome de Wolff-Parkinson-White/cirurgia , Adulto , Ponte Cardiopulmonar , Anomalia de Ebstein/epidemiologia , Seguimentos , Parada Cardíaca Induzida , Humanos , Modelos Logísticos , Reoperação , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Valva Tricúspide/cirurgia , Síndrome de Wolff-Parkinson-White/epidemiologiaRESUMO
INTRODUCTION: Many issues regarding the recurrence of accessory pathway conduction and the long-term outcome of late block of accessory pathway conduction are still unknown or controversial. METHODS AND RESULTS: Data from 217 patients who underwent an initially successful radiofrequency ablation of accessory pathways and 7 patients with late block of accessory pathway conduction following an initially unsuccessful ablation were analyzed. During a mean follow-up of 19 +/- 11 months, accessory pathway conduction resumed in 21 (10%) of 217 patients following an initially successful ablation and in 6 (86%) of 7 patients with late block of accessory pathway conduction (P < 0.01). After initially successful ablations, the recurrence rates of accessory pathway conduction at 1, 3, and 6 months were 5.9%, 7.4%, and 11.3%, respectively. A late electrophysiologic study at 6 months uncovered recurrence in only 1 of 124 asymptomatic patients, but failed to detect the late recurrence in 2 patients in whom the accessory pathway conduction resumed after more than 6 months. Multivariate analysis revealed that independent predictors for recurrence of accessory pathway conduction were concealed accessory pathway, presence of transient effect of radiofrequency pulse, and more than 5 pulses required for initial cure. Accessory pathway location, length of the tip electrode of the ablation catheter, and repeat radiofrequency pulses ("safety pulses") after effective pulses did not predict resumption of accessory pathway conduction. CONCLUSIONS: After initially successful ablation, the recurrence rates of accessory pathway conduction at 1, 3, and 6 months were 5.9%, 7.4%, and 11.3%, respectively. Late electrophysiologic testing had little prognostic value in asymptomatic patients following successful ablation. Application of "safety pulses" did not prevent recurrence. Late block of accessory pathway conduction did not predict long-term efficacy.
Assuntos
Ablação por Cateter , Síndrome de Wolff-Parkinson-White/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Reoperação , Síndrome de Wolff-Parkinson-White/etiologiaRESUMO
A surface electrocardiogram showing type B Wolff-Parkinson-White syndrome pattern was part of the cardiac findings in a female of 24 with florid features of tuberous sclerosis. She had cardiomegaly but no intracardiac tumour was demonstrated. Wolff-Parkinson-White syndrome, though rare, has previously been described in association with tuberous sclerosis in children but not before in adults.
Assuntos
Esclerose Tuberosa/complicações , Síndrome de Wolff-Parkinson-White/etiologia , Adenoma/complicações , Adulto , Eletrocardiografia , Neoplasias Faciais/complicações , Feminino , Fibroma/complicações , Humanos , Neoplasias Primárias Múltiplas , Neoplasias Cutâneas/complicaçõesRESUMO
OBJECTIVE: A description of two infants with ventricular preexcitation syndrome and supraventricular tachycardia associated with rhabdomyoma and review of the literature. DESIGN: A review of two patients who were seen between 1981 and 1986 in the cardiology department. SETTING: Pediatric Heart Institute at St Christopher's Hospital for Children, Philadelphia, Pa. PARTICIPANTS: Two newborn female infants with ventricular preexcitation syndrome, supraventricular tachycardia, rhabdomyomatous tumor of the heart, and tuberous sclerosis are described. RESULTS: The first patient had unsuccessful partial resection of the rhabdomyomatous tumors obstructing the tricuspid valve and right ventricular cavity and died immediately after surgery. By histologic examination, no direct accessory connection was noted between the myocardial fibers of atria and ventricles through annulus fibrosus. By gross examination, the tumor extended from the right atrium through the tricuspid valve to the right ventricular cavity, suggestive of macroscopic accessory connection. The second patient presented with unsustained ventricular tachycardia and obstructive subaortic rhabdomyoma, requiring emergency surgery. One week later, reentrant supraventricular tachycardia developed and she required digoxin therapy for 15 months. CONCLUSIONS: Infants with rhabdomyomatous tumor of the heart and ventricular preexcitation syndrome may have microscopic or macroscopic accessory connections. Cardiac tumors like rhabdomyoma and oncocytic tumors should be suspected in infants with ventricular preexcitation syndrome or supraventricular tachycardia.
Assuntos
Neoplasias Cardíacas/complicações , Rabdomioma/complicações , Taquicardia Supraventricular/etiologia , Esclerose Tuberosa/complicações , Síndrome de Wolff-Parkinson-White/etiologia , Feminino , Átrios do Coração , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirurgia , Ventrículos do Coração , Humanos , Recém-Nascido , Rabdomioma/diagnóstico , Rabdomioma/cirurgia , Valva Tricúspide , Esclerose Tuberosa/diagnósticoRESUMO
The Wolff-Parkinson-White syndrome is caused by a congenital accessory connection between the atrium and ventricle. We describe a case of symptomatic Wolff-Parkinson-White syndrome that arose after a Björk modification of the Fontan operation. Invasive electrophysiologic and intraoperative mapping indicated that the surgically created atrioventricular connection was functioning as an accessory pathway. Surgical dissection and cryoablation abolished the symptoms and the preexcitation.