RÉSUMÉ
A 23-year-old male with a history of ventricular pre-excitation and atrial flutter presented for evaluation after recurrent syncope. The possible mechanism of syncope erroneously attributed to pre-excited atrial flutter with fast heart rates in the first hospitalization. The patient was found to have advanced heart block and PRKAG2 genetic mutation in the second hospitalization. The genetic findings and clinical features are consistent with PRKAG2 syndrome (PS). PS is a rare, autosomal dominant inherited disease, characterized by ventricular pre-excitation, supraventricular tachycardia, and cardiac hypertrophy. It is frequently followed by atrial-fibrillation-induced ventricular fibrillation and advanced heart blocks. An accurate differential diagnosis of syncope is important because of the different arrhythmic features and clinical course of PS.
Sujet(s)
Faisceau accessoire atrioventriculaire , Électrocardiographie , Syncope , Humains , Mâle , Jeune adulte , Électrocardiographie/méthodes , Faisceau accessoire atrioventriculaire/physiopathologie , Diagnostic différentiel , Syncope/étiologie , AMP-Activated Protein Kinases/génétique , SyndromeRÉSUMÉ
AIMS: Radiofrequency ablation is used as a first-line therapy for accessory pathways (APs). However, data regarding the effects of pulsed field ablation (PFA) on APs are limited. We sought to evaluate the acute procedural and 6-month success and safety of PFA in a cohort of patients with APs. METHODS AND RESULTS: A focal contact force-sensing PFA catheter was used for patients with APs. Pulsed field ablation generator generated a bipolar and biphasic waveform (±1000â V) with a duration of 100â ms from the tip of the PFA catheter. A 100% acute procedural success was achieved in 10 conscious patients with APs (7 left anterolateral, 2 left inferolateral, and 1 right posteroseptal APs) including 6 (60%) patients after an initial application. The average total ablation time was 6.3 ± 4.9â s for 4.7 ± 1.8 ablation sites (ASs), including 3.1 ± 2.4â s at targets and 3.2 ± 2.9â s at 3.2 ± 2 bolus ASs. The mean skin-to-skin time was 59.3 ± 15.5â min, and PFA catheter dwell time was 29.4 ± 7.8â min. One patient encountered transient sinus arrest during PFA due to parasympathetic overexcitation. Sinus rhythm was restored in all patients without any significant adverse events during the short-term follow-up. CONCLUSION: Pulsed field ablation of APs was feasible, effective, and safe. Its efficiency was remarkable for its ultrarapid termination of AP conduction. Further studies are warranted to prove whether utilization of PFA with current parameters can extend to manifold AP ablation.
Sujet(s)
Faisceau accessoire atrioventriculaire , Ablation par cathéter , Humains , Projets pilotes , Femelle , Mâle , Faisceau accessoire atrioventriculaire/chirurgie , Faisceau accessoire atrioventriculaire/physiopathologie , Résultat thérapeutique , Adulte , Ablation par cathéter/méthodes , Ablation par cathéter/effets indésirables , Adulte d'âge moyen , Jeune adulte , Facteurs temps , Rythme cardiaque , Adolescent , Sondes cardiaquesRÉSUMÉ
BACKGROUND: The anatomy of myocardial fibers around the right cardiac veins (RCVs) and their roles in accessory pathways (APs) are rarely reported. METHODS: Six RCV-APs were identified from 566 patients with right-sided APs. Mapping of retrograde atrial activation was performed using CARTO 3 system under orthodromic tachycardia or right ventricular pacing. Venography of RCVs was acquired at the earliest retrograde atrial activation. RESULTS: Patients enrolled had a median age of 30 (11-51) years, 5 of them were male. Venography of RCVs could be classified into 3 distinct patterns based on the identified ventricular branches, right marginal vein only (type I; n=3), both right marginal vein and anterior cardiac veins (type II; n=2), and anterior cardiac vein only (type III; n=1). Patients with type I venography had rS QRS pattern in lead V1, negative delta wave in lead III and negative or isoelectric delta wave in lead aVF. However, patients with type II and III venography had QS QRS patterns in lead V1 and variable patterns of delta wave in inferior leads. Earliest retrograde atrial activation was found at a median of 16.75 (14.60-20.00) mm away from the tricuspid annulus, all with A larger than V. At the earliest retrograde atrial activation, far-field ventricular electrogram was found 30 ms later than QRS onset in 1 patient under sinus rhythm. AP conduction was eliminated by mechanical pressure in 2 and by radiofrequency ablation in 4 at the ostium of the veins colocalizing with the earliest retrograde activation of the right atrium. No recurrence was observed during 36 (10-60) months follow-up. CONCLUSIONS: The RCV-AP is a rare form of right-sided APs characterized by atrial insertions distant from the annulus. ECG-speculated ventricular insertion sites conformed to the location of identified RCVs.
Sujet(s)
Faisceau accessoire atrioventriculaire , Ablation par cathéter , Phlébographie , Humains , Mâle , Adulte , Femelle , Adulte d'âge moyen , Faisceau accessoire atrioventriculaire/physiopathologie , Faisceau accessoire atrioventriculaire/chirurgie , Adolescent , Jeune adulte , Enfant , Techniques électrophysiologiques cardiaques , Vaisseaux coronaires/physiopathologie , Vaisseaux coronaires/imagerie diagnostique , Potentiels d'action , Rythme cardiaque , Entraînement électrosystoliqueRÉSUMÉ
INTRODUCTION: Precise electrocardiographic localization of accessory pathways (AP) can be challenging. Seminal AP localization studies were limited by complexity of algorithms and sample size. We aimed to create a nonalgorithmic method for AP localization based on color-coded maps of AP distribution generated by a web-based application. METHODS: APs were categorized into 19 regions/types based on invasive electrophysiologic mapping. Preexcited QRS complexes were categorized into 6 types based on polarity and notch/slur. For each QRS type in each lead the distribution of APs was visualized on a gradient map. The principle of common set was used to combine the single lead maps to create the distribution map for AP with any combination of QRS types in several leads. For the validation phase, a separate cohort of APs was obtained. RESULTS: A total of 800 patients with overt APs were studied. The application used the exploratory data set of 553 consecutive APs and the corresponding QRS complexes to generate AP localization maps for any possible combination of QRS types in 12 leads. Optimized approach (on average 3 steps) for evaluation of preexcited electrcardiogram was developed. The area of maximum probability of AP localization was pinpointed by providing the QRS type for the subsequent leads. The exploratory data set was validated with the separate cohort of APs (n = 256); p = .23 for difference in AP distribution. CONCLUSIONS: In the largest data set of APs to-date, a novel probabilistic and semi-automatic approach to electrocardiographic localization of APs was highly predictive for anatomic localization.
Sujet(s)
Faisceau accessoire atrioventriculaire , Potentiels d'action , Techniques électrophysiologiques cardiaques , Rythme cardiaque , Applications mobiles , Valeur prédictive des tests , Humains , Faisceau accessoire atrioventriculaire/physiopathologie , Reproductibilité des résultats , Mâle , Femelle , Traitement du signal assisté par ordinateur , Électrocardiographie , Adulte , Algorithmes , Facteurs temps , Adulte d'âge moyen , Jeune adulteRÉSUMÉ
BACKGROUND: Accurate estimation of accessory pathway (AP) localization in patients with ventricular pre-excitation or Wolff-Parkinson-White (WPW) syndrome remains a diagnostic challenge. Existing algorithms have contributed significantly to this area, but alternative algorithms can offer additional perspectives and approaches to AP localization. OBJECTIVE: This study introduces and evaluates the diagnostic accuracy of the EPM algorithm in AP localization, comparing it with established algorithms Arruda and EASY. METHODS: A retrospective analysis was conducted on 138 patients from Hospital São Paulo who underwent catheter ablation. Three blinded examiners assessed the EPM algorithm's diagnostic accuracy against the Arruda and EASY algorithms. The gold standard for comparison was the radioscopic position of the AP where radiofrequency ablation led to pre-excitation disappearance on the ECG. RESULTS: EPM showed a diagnostic accuracy of 51.45%, closely aligning with Arruda (53.29%) and EASY (44.69%). Adjacency accuracy for EPM was 70.67%, with Arruda at 66.18% and EASY at 72.22%. Sensitivity for EPM in distinguishing left vs. right APs was 95.73%, with a specificity of 74.33%. For identifying septal vs. lateral right APs, EPM sensitivity was 82.79% with a specificity of 46.15%. These measures were comparable to those of Arruda and EASY. Inter-observer variability was excellent for EPM, with Kappa statistics over 0.9. CONCLUSION: The EPM algorithm emerges as a reliable tool for AP localization, offering a systematic approach beneficial for therapeutic decision-making in electrophysiology. Its comparable diagnostic accuracy and excellent inter-observer variability underscore its potential clinical applicability. Future research may further validate its efficacy in a broader clinical setting.
Sujet(s)
Faisceau accessoire atrioventriculaire , Algorithmes , Électrocardiographie , Sensibilité et spécificité , Syndrome de Wolff-Parkinson-White , Humains , Faisceau accessoire atrioventriculaire/physiopathologie , Faisceau accessoire atrioventriculaire/chirurgie , Mâle , Femelle , Syndrome de Wolff-Parkinson-White/physiopathologie , Syndrome de Wolff-Parkinson-White/chirurgie , Syndrome de Wolff-Parkinson-White/diagnostic , Études rétrospectives , Adulte , Ablation par cathéter , Reproductibilité des résultats , Syndromes de préexcitation/physiopathologie , Syndromes de préexcitation/diagnostic , Adulte d'âge moyenSujet(s)
Cardiomyopathies , Ablation par cathéter , Défaillance cardiaque , Humains , Ablation par cathéter/effets indésirables , Défaillance cardiaque/chirurgie , Cardiomyopathies/chirurgie , Cardiomyopathies/complications , Mâle , Femelle , Adulte d'âge moyen , Adulte , Faisceau accessoire atrioventriculaire/chirurgie , Faisceau accessoire atrioventriculaire/physiopathologieSujet(s)
Faisceau de His , Bloc de branche , Entraînement électrosystolique , Électrocardiographie , Septum interventriculaire , Humains , Faisceau accessoire atrioventriculaire/physiopathologie , Faisceau de His/physiopathologie , Bloc de branche/physiopathologie , Bloc de branche/thérapie , Entraînement électrosystolique/méthodesSujet(s)
Faisceau accessoire atrioventriculaire , Cardiomyopathie hypertrophique , Faucons , Syndromes de préexcitation , Humains , Animaux , Columbidae , Faisceau accessoire atrioventriculaire/physiopathologie , Syndromes de préexcitation/diagnostic , Cardiomyopathie hypertrophique/complications , Cardiomyopathie hypertrophique/diagnosticSujet(s)
Faisceau accessoire atrioventriculaire , Électrocardiographie/méthodes , Tachycardie jonctionnelle ectopique , Tachycardie réciproque , Tachycardie supraventriculaire , Faisceau accessoire atrioventriculaire/diagnostic , Faisceau accessoire atrioventriculaire/physiopathologie , Faisceau accessoire atrioventriculaire/chirurgie , Adulte , Électrophysiologie cardiaque , Ablation par cathéter/méthodes , Diagnostic différentiel , Échocardiographie/méthodes , Techniques électrophysiologiques cardiaques , Système de conduction du coeur/physiopathologie , Humains , Mâle , Débit systolique , Tachycardie jonctionnelle ectopique/diagnostic , Tachycardie jonctionnelle ectopique/physiopathologie , Tachycardie réciproque/diagnostic , Tachycardie réciproque/physiopathologie , Tachycardie supraventriculaire/diagnostic , Tachycardie supraventriculaire/physiopathologie , Résultat thérapeutiqueRÉSUMÉ
BACKGROUND: Since the early descriptions of large series of accessory atrioventricular pathway ablations in adults and adolescents over 20 years ago, there have been limited published reports based on more recent experiences of large referral centers. We aimed to characterize accessory pathway distribution and features in a large community-based population that influence ablation outcomes using a tiered approach to ablation. METHODS: Retrospective analysis of 289 patients (age 14-81) who underwent accessory ablation from 2015-2019 was performed. Pathways were categorized into anteroseptal, left freewall, posteroseptal, and right freewall locations. We analyzed patient and pathway features to identify factors associated with prolonged procedure time parameters. RESULTS: Initial ablation success rate was 94.7% with long-term success rate of 93.4% and median follow-up of 931 days. Accessory pathways were in left freewall (61.6%), posteroseptal (24.6%), right freewall (9.6%), and anteroseptal (4.3%) locations. Procedure outcome was dependent on pathway location. Acute success was highest for left freewall pathways (97.1%) with lowest case times (144 ± 68 min) and fluoroscopy times (15 ± 19 min). Longest procedure time parameters were seen with anteroseptal, left anterolateral, epicardial-coronary sinus, and right anterolateral pathway ablations. CONCLUSIONS: In this community-based adult and adolescent population, majority of the accessory pathways are in the left freewall and posteroseptal region and tend to be more easily ablated. A tiered approach with initial use of standard ablation equipment before the deployment of more advance tools, such as irrigated tips and 3D mapping, is cost effective without sacrificing overall efficacy.
Sujet(s)
Faisceau accessoire atrioventriculaire/chirurgie , Troubles du rythme cardiaque/chirurgie , Ablation par cathéter/tendances , Services de santé communautaires/tendances , Prestation intégrée de soins de santé/tendances , Types de pratiques des médecins/tendances , Irrigation thérapeutique/tendances , Faisceau accessoire atrioventriculaire/diagnostic , Faisceau accessoire atrioventriculaire/économie , Faisceau accessoire atrioventriculaire/physiopathologie , Potentiels d'action , Adolescent , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Troubles du rythme cardiaque/diagnostic , Troubles du rythme cardiaque/économie , Troubles du rythme cardiaque/physiopathologie , Ablation par cathéter/effets indésirables , Ablation par cathéter/économie , Prise de décision clinique , Services de santé communautaires/économie , Analyse coût-bénéfice , Prestation intégrée de soins de santé/économie , Femelle , Coûts des soins de santé/tendances , Rythme cardiaque , Humains , Mâle , Adulte d'âge moyen , Durée opératoire , Types de pratiques des médecins/économie , Études rétrospectives , Irrigation thérapeutique/effets indésirables , Irrigation thérapeutique/économie , Facteurs temps , Résultat thérapeutique , Jeune adulteRÉSUMÉ
Block in accessory pathway (AP) conduction with adenosine has been previously described. However, conduction characteristics of these APs has not been well defined to date. All patients with APs = 21 years old who underwent an EP study from 2014 to 2017 were included in our study. Patients with adenosine sensitive APs were identified (group 1). Demographic and AP conduction characteristics were compared between group 1 and the entire cohort of patients. Local atrioventricular (AV) or ventriculoatrial (VA) time, cycle length and need for isoproterenol were compared to a control group matched by age and AP location (group 2). Student's t test, Wilcoxon rank sum, χ2 and Fisher's exact were used for analysis. Fourteen (7%) out of 207 patients had an adenosine sensitive AP. The median age of patients with adenosine sensitive APs was 11.8 (IQR 8.5-13.5) years vs. 14 (IQR 10.6-16.7) for the rest of the cohort (p = 0.04). Three of the 134 patients with preexcitation had adenosine sensitive APs (2%) vs. 11 of the 73 patients with concealed APs (15%) (p = 0.001). The median local AV/VA time at the site of successful ablation was longer in group 1 vs group 2 [78 ms, IQR 62-116 vs. 31 ms, IQR 30-38; p < 0.001]. Antegrade AP effective refractory period and total procedure time were longer in patients with adenosine sensitive APs (p = 0.03 & p = 0.04, respectively). Adenosine sensitive APs which occur in children are more often concealed. These APs have a longer conduction time at the site of successful ablation.
Sujet(s)
Faisceau accessoire atrioventriculaire/chirurgie , Adénosine/pharmacologie , Ablation par cathéter/méthodes , Électrocardiographie/méthodes , Rythme cardiaque/physiologie , Syndromes de préexcitation/chirurgie , Faisceau accessoire atrioventriculaire/traitement médicamenteux , Faisceau accessoire atrioventriculaire/physiopathologie , Adolescent , Antiarythmiques/pharmacologie , Enfant , Femelle , Rythme cardiaque/effets des médicaments et des substances chimiques , Humains , Mâle , Syndromes de préexcitation/physiopathologieRÉSUMÉ
BACKGROUND: Studies have suggested that a fasciculoventricular pathway (FVP) may be the cause of preexcitation in patients with Danon disease, a rare X-linked dominant genetic disorder of hypertrophic cardiomyopathy. OBJECTIVE: The purpose of this study was to describe the prevalence of ventricular preexcitation on resting 12-lead electrocardiogram (ECG) in patients with Danon disease and the electrophysiological study (EPS) results of those with preexcitation. METHODS: Patients with confirmed Danon disease diagnosed with preexcitation (PR ≤120 ms, delta wave, QRS >110 ms) on ECG were included from a multicenter registry. The incidence of arrhythmias, implantable cardioverter-defibrillator (ICD) procedures, ICD shocks, and EPS results were collected. RESULTS: Thirteen of 40 patients (32.5%) with Danon disease were found to have preexcitation (mean age 17.3 years; 38% women). EPS performed in 9 of 13 patients (69%) demonstrated FVP only in 2 (22.2%), extranodal pathway without exclusion of FVP in 2 (22.2%), and both FVP and extranodal pathway in 5 (55.6%). Two patients had malignant accessory pathway (AP) properties. Over median follow-up of 842 days (interquartile range 138-1678), 11 patients (85%) had ICD placement, and 6 (46.1%) underwent heart transplantation. No patients required therapy for ventricular tachycardia, and 2 patients (15%) had paroxysmal atrial fibrillation. CONCLUSION: In a large multicenter cohort of patients with Danon disease, there was a high prevalence of FVP and extranodal pathways diagnosed on EPS in those with preexcitation. These findings suggest patients with preexcitation and Danon disease should undergo EPS to assess for FVP and potentially malignant extranodal AP.
Sujet(s)
Faisceau accessoire atrioventriculaire/complications , Faisceau de His/physiopathologie , Électrocardiographie , Glycogénose de type IIb/complications , Syndromes de préexcitation/étiologie , Enregistrements , Faisceau accessoire atrioventriculaire/épidémiologie , Faisceau accessoire atrioventriculaire/physiopathologie , Adolescent , Adulte , Enfant , ADN/génétique , Analyse de mutations d'ADN , Femelle , Études de suivi , Glycogénose de type IIb/génétique , Humains , Incidence , Protéine de membrane-2 associée au lysosome/génétique , Mâle , Mutation , Syndromes de préexcitation/épidémiologie , Syndromes de préexcitation/physiopathologie , Prévalence , Études rétrospectives , Facteurs temps , États-Unis/épidémiologie , Jeune adulteSujet(s)
Faisceau accessoire atrioventriculaire/physiopathologie , Troubles du rythme cardiaque/diagnostic , Faisceau accessoire atrioventriculaire/chirurgie , Adolescent , Troubles du rythme cardiaque/physiopathologie , Troubles du rythme cardiaque/chirurgie , Électrocardiographie , Femelle , Humains , Ablation par radiofréquenceRÉSUMÉ
We described a 15-year-old boy who underwent the catheter ablation for the nodoventricular (NV) tachycardia that had difficulty in differentiation from atrioventricular nodal reentrant tachycardia with upper common pathway. The modification of the fast pathway revealed an anterograde conduction of the NV fiber. We successfully performed the catheter ablation targeting for the right ventricular insertion site of the NV fiber.
Sujet(s)
Faisceau accessoire atrioventriculaire/chirurgie , Ablation par cathéter , Tachycardie supraventriculaire/chirurgie , Faisceau accessoire atrioventriculaire/complications , Faisceau accessoire atrioventriculaire/physiopathologie , Adolescent , Humains , Mâle , Tachycardie supraventriculaire/complications , Tachycardie supraventriculaire/physiopathologieRÉSUMÉ
BACKGROUND: Little is known about the effects of preoperative electrophysiological study (EPS) and catheter ablation (CA) in Fontan surgery candidates with supraventricular tachycardia (SVT). OBJECTIVE: The purpose of this study was to investigate the clinical impact of EPS-guided intervention in Fontan surgery candidates with preceding SVT events. METHODS: A total of 109 consecutive patients with a history of SVT before Fontan surgery were divided into 3 groups: 44 in whom EPS with CA was attempted (CA group); 21 in whom EPS without CA was attempted (EPS group); and 44 in whom EPS was not performed (N group). The incidence and diagnosis of SVT, acute success rate of CA, and risk factors of peri/postoperative SVT were retrospectively investigated. RESULTS: The total incidence of SVT within 1 year after Fontan surgery was 34% (n = 37), with 91% of cases occurring within 1 month. Among the 71 SVT incidences diagnosed with EPS, 31 were atrioventricular reentrant tachycardias (AVRTs) involving twin atrioventricular nodes, 12 were atrioventricular nodal reentrant tachycardias, 12 were atrial tachycardias, 7 were orthodromic AVRTs via the accessory pathway, 7 were atrial flutters, and 2 were junctional tachycardias. The acute success rate of CA was 91% (48/53). The rate of peri/postoperative atrioventricular reciprocating SVT was significantly lower in the CA group than in the N or EPS group (11% vs 43% or 43%; P <.05). No/unsuccessful CA significantly increased the risk of peri/postoperative SVT in multivariate analysis (odds ratio 4.43; 95% confidence interval 1.69-11.59). CONCLUSION: Preoperative CA reduces peri/postoperative SVT occurrence in Fontan surgery candidates at high risk for SVT.
Sujet(s)
Faisceau accessoire atrioventriculaire/physiopathologie , Ablation par cathéter , Techniques électrophysiologiques cardiaques/méthodes , Procédure de Fontan/effets indésirables , Tachycardie supraventriculaire/physiopathologie , Adolescent , Enfant , Enfant d'âge préscolaire , Femelle , Études de suivi , Cardiopathies congénitales/chirurgie , Humains , Incidence , Japon/épidémiologie , Mâle , Période périopératoire , Période postopératoire , Études rétrospectives , Facteurs de risque , Tachycardie supraventriculaire/épidémiologie , Tachycardie supraventriculaire/étiologieRÉSUMÉ
A 40-year-old man presented to our emergency department 2 hours after onset of shortness of breath, palpitations, and presyncope secondary to an adenosine-responsive wide complex tachycardia. Electrophysiology study was diagnostic for antidromic atrioventricular (AV) reentrant tachycardia utilizing a muscular connection from the anterior interventricular vein to the left ventricle with Mahaim-like properties, successfully treated with ablation in the distal coronary sinus (CS) system. This case highlights accessory pathways (a) with unique features (i.e., Mahaim-like characteristics) and (b) involving musculature from the distal CS system, thereby limiting the value of endocardial ablation for durable treatment. Importantly, the coronary venous system is an accessible vascular network for evaluation and catheter ablation of such arrhythmias.
Sujet(s)
Ablation par cathéter/méthodes , Sinus coronaire/chirurgie , Tachycardie par réentrée intranodale/diagnostic , Tachycardie par réentrée intranodale/chirurgie , Faisceau accessoire atrioventriculaire/physiopathologie , Adulte , Diagnostic différentiel , Électrocardiographie , Humains , Mâle , Tachycardie par réentrée intranodale/physiopathologieRÉSUMÉ
Over the last decades, the approach to the Wolff-Parkinson-White syndrome, as well as its treatment, has substantially changed, leading to improvement in the prognosis and quality of life of these patients. From the first diagnostic electrophysiologic studies to the most recent evaluations, important data on pathophysiologic and clinical aspects have been gathered, and this learning journey is still not concluded. This body of knowledge is a fundamental part of any cardiologists' armamentarium despite the fact that this syndrome is rarely observed in adult patients.
Sujet(s)
Faisceau accessoire atrioventriculaire/physiopathologie , Syndrome de Wolff-Parkinson-White , Sujet âgé de 80 ans ou plus , Ablation par cathéter , Mort subite cardiaque/prévention et contrôle , Électrocardiographie , Femelle , Humains , Tachycardie ventriculaire/physiopathologie , Syndrome de Wolff-Parkinson-White/physiopathologie , Syndrome de Wolff-Parkinson-White/prévention et contrôle , Syndrome de Wolff-Parkinson-White/chirurgieRÉSUMÉ
Ventricular preexcitation is a depolarization of the ventricles that occurs before the conventional sequence, and the electrocardiogram is the specific test for diagnosis. A Kent bundle is the paradigm of ventricular preexcitation, and it is associated with short PR, wide QRS and delta wave. This finding is not always very evident, as it can have different degrees of pre-eccitazione; therefore great diagnostic care must be taken in this field. If not properly identified, the pattern of ventricular preexcitation may lead to an incorrect diagnosis. The methodology of precision electrocardiology is able to confront all these aspects.
Sujet(s)
Système de conduction du coeur/physiopathologie , Syndromes de préexcitation/physiopathologie , Faisceau accessoire atrioventriculaire/physiopathologie , Sujet âgé de 80 ans ou plus , Électrocardiographie , Ventricules cardiaques/physiopathologie , Humains , MâleRÉSUMÉ
An accessory pathway (AP) can be apparent during sinus rhythm if it depolarizes part of the ventricles ahead of the normal wave front from the conduction system. An AP can generate an anatomic circuit able to sustain a macroreentrant atrioventricular reentrant tachycardia. This arrhythmia can engage the normal conducting system in an antegrade direction or retrogradely, generating, respectively, a narrow or a wide complex tachycardia. The combined use of a standard electrocardiogram and an esophageal recording-pacing can be particularly useful in the first approach to patients with Wolff-Parkinson-White syndrome, further stratifying patients requiring electrophysiology study and transcatheter ablation.