Atrial Fibrillation in WPW Syndrome
AbstractBackground : In large-scale general population studies involving children and adults, the prevalence of WPW is estimated to be 1–3 in 1000 individuals. At present, it is estimated that approximately 65% of adolescents and 40% of individuals over 30 years with WPW pattern on a resting ECG are asymptomatic. An incidence of 4.5 episodes of sudden death, including resuscitated sudden cardiac death (SCD), per 1000 patient-years was recently reported. The mechanism of sudden cardiac death in patients with WPW is thought to be associated with atrial fibrillation
Case Illustration : We reported a case of 45 year old female came with unstable irregular wide complex tachycardia in the form of pre-excited AF. Cardioversion successfully terminate the tachyaarhythmias. ECG in sinus rhythm revealed WPW pattern ECG. Patient then referred for catheter ablation. Successful ablation was done resulting a normal pattern ECG
Conclusion : AF in WPW syndrome could lead to devastating events such as cardiac arrest. ECG recognition at the first place is very important for early management. Early stratification and management in patients with WPW is important to diminished the risk of AF occurence and SCD.
2. Issa Z. Atrioventricular Reentrant Tachycardia. In: Zipes DP, John M, ed. Clinical arrhythmology and electrophysiology : a companion to Braunwald’s heart disease. Philadelphia: Elsevier; 2009:319-61.
3. Wood M. Catheter ablation of accessory atrioventricular connections. In: S Huang MW, ed. Catheter ablation of cardiac arrhythmias. Philadelphia: Elsevier; 2010:364-5.
4. Pappone C, Santinelli V, Rosanio S, et al. Usefulness of invasive electrophysiologic testing to stratify the risk of arrhythmic events in asymptomatic patients with Wolff-Parkinson-White pattern: results from a large prospective long-term follow-up study. J Am Coll Cardiol 2003;41:239-44.
5. G Hessling MS, et al. Accessory pathway. In: C Schmitt ID, B Zrenner, ed. Catheter Ablation of Cardiac Arrhythmias A Practical Approach. Wuzburg: Springer; 2006:77-82.
6. Cain ME, Luke RA, Lindsay BD. Diagnosis and localization of accessory pathways. Pacing Clin Electrophysiol 1992;15:801-24.
7. Sanjeev S SB, Shih-Ann C. Paroxysmal Supraventricular Tachycardias and the Preexcitation Syndrome. In: Sanjeev S JC, ed. Electrophysiological disorders of the heart. Philadelphia: Elsevier; 2005:267-68.
8. Chen SA, Tai CT, Chiang CE, et al. Electrophysiologic characteristics, electropharmacologic responses and radiofrequency ablation in patients with decremental accessory pathway. J Am Coll Cardiol 1996;28:732-7.
9. Al-Khatib SM, Pritchett EL. Clinical features of Wolff-Parkinson-White syndrome. Am Heart J 1999;138:403-13.
10. Dreifus LS, Haiat R, Watanabe Y, Arriaga J, Reitman N. Ventricular fibrillation. A possible mechanism of sudden death in patients and Wolff-Parkinson-White syndrome. Circulation 1971;43:520-7.
11. Fukatani M, Tanigawa M, Mori M, et al. Prediction of a fatal atrial fibrillation in patients with asymptomatic Wolff-Parkinson-White pattern. Jpn Circ J 1990;54:1331-9.
12. Brembilla-Perrot B, Moejezi RV, Zinzius PY, et al. Missing diagnosis of preexcitation syndrome on ECG: clinical and electrophysiological significance. Int J Cardiol 2011;163:288-93.
13. Fujimura O, Klein GJ, Yee R, Sharma AD. Mode of onset of atrial fibrillation in the Wolff-Parkinson-White syndrome: how important is the accessory pathway? J Am Coll Cardiol 1990;15:1082-6.
14. Centurion OA, Shimizu A, Isomoto S, Konoe A. Mechanisms for the genesis of paroxysmal atrial fibrillation in the Wolff Parkinson-White syndrome: intrinsic atrial muscle vulnerability vs. electrophysiological properties of the accessory pathway. Europace 2008;10:294-302.
15. Fogoros R. The Electrophysiology Study in the Evaluation of Supraventricular Tachyarrhythmias. In: Fogoros R, ed. Electrophysiologic testing. Oxford: Blackwell; 2006:130-3.
16. Chi K AN, Arruda M. Ablation of SVT. In: Natale A, ed. Handbook of Cardiac Electrophysiology. London: Informa; 2007:265-6.
17. Fengler BT, Brady WJ, Plautz CU. Atrial fibrillation in the Wolff-Parkinson-White syndrome: ECG recognition and treatment in the ED. Am J Emerg Med 2007;25:576-83.
PDF downloads: 794
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).