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Common cardiac conditions, drugs and methods of assessment
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Wolff-Parkinson-White syndrome is a congenital abnormality in about 0.2% of the population. It involves an additional conducting system between the atria and ventricles, giving rise to supraventricular arrhythmias. Normal anti-arrhythmic drugs may not work, but it may be possible to control paroxysmal supraventricular tachycardia by vagal control (e.g., respiratory effort) or it may resolve spontaneously. However, drugs (e.g., beta blockers) or direct current shock (defibrillation) may also be necessary (Downie, et al., 2003). The best treatment is to ablate (destroy) the accessory pathway before pregnancy.
The QRS complex
Published in Andrew R Houghton, Making Sense of the ECG, 2019
Patients with Wolff–Parkinson–White syndrome characteristically exhibit a delta wave that slurs the upstroke of the QRS complex (see Chapter 7, Figure 7.15). This diagnosis should be suspected if, in addition, the PR interval is abnormally short. For more information on the diagnosis and management of Wolff–Parkinson–White syndrome, see Chapter 7.
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Published in Anton Sebastian, A Dictionary of the History of Medicine, 2018
Ablation Catheter G. Giraud, P. Puech and H. Latour used an electrode catheter in humans in 1960. Benjamin Scherlag of Columbia University developed a catheter for recording electrical activity of the bundle of His in 1969 and an experimental method for injecting formaldehyde to block the bundle of His and produce complete heart block. This work formed the basis for electrophysiological studies of the heart and development of electrode catheter ablation by R. Gonzalez and co-workers in 1981. A transvenous catheter to deliver high energy direct electrical current for ablation of the aberrant pathway in Wolff–Parkinson-White syndrome was devised by F. Morady and M.M.Scheinmann in 1984. A laser balloon catheter was developed by J. Richard Spears in 1987. See Wolf–Parkinson–White syndrome.
Opsoclonus myoclonus and ataxia syndrome with supraventricular tachycardia
Published in Baylor University Medical Center Proceedings, 2023
Sydney Garner, Alec Giakas, Katherine Holder, Bernardo Galvan, Hollie Edwards
An overnight electroencephalogram showed motion artifact due to near-constant myoclonus but otherwise normal brain activity. Lumbar puncture revealed no evidence of paraneoplastic, autoimmune, or infectious processes. Due to concern for a metabolic process, additional laboratory tests were sent out, including lactic acid, organic acids, plasma total and free carnitine, acylcarnitine, and cell pellet to bank DNA. The patient was then started on IVIG and dexamethasone. After his first infusion of IVIG, his abnormal movements worsened, his heart rate increased into the 300s, and telemetry showed an absence of P waves, consistent with SVT. He did not respond to ice or vagal maneuvers so his heart rate was controlled with adenosine. Follow-up electrocardiogram excluded Wolff-Parkinson-White syndrome and other pathologies. An echocardiogram showed no structural abnormalities. He was then started on propranolol. While in the pediatric intensive care unit, the patient experienced four episodes of SVT, two of which self-resolved and two of which resolved with vagal maneuvers.
Simple electrocardiography algorithm for localizing accessory pathway in patients with Wolff–Parkinson–White syndrome
Published in Acta Cardiologica, 2022
Sunu Budhi Raharjo, Ardhestiro Hanindyo Putro, Anwar Santoso, Dicky Armein Hanafy, Dony Yugo Hermanto, Sarah Humaira, Yoga Yuniadi
Since the advancement of radiofrequency catheter ablation to treat Wolff–Parkinson–White syndrome (WPW) in the mid-eighties, the knowledge of the location and anatomy of an accessory pathway (AP) became increasingly important. The procedural approach heavily depends on the location of AP. The 12-lead surface ECG is integral in deciding the procedural approach for electrophysiological study (EPS) and subsequent radiofrequency catheter ablation [1]. This has led to the development of algorithms aimed to predict the AP location with information derived from 12-lead surface ECG. These algorithms have various ECG criteria, different gold standards, and nomenclatures, with a wide extent of predicted regions (ranging from broad to extremely precise). Although these algorithms have good sensitivity and specificity, they are complex, difficult to memorise with low to medium accuracy, and inter-observer agreement rates [2–4].
Coronary artery occlusion following low-power catheter ablation
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Sakiru O. Isa, Mahin R. Khan, Hameem U. Changezi, Mustafa Hassan
Catheter directed radiofrequency ablation (RFA) is an effective and safe option for the treatment of re-entrant tachycardias associated with Wolff-Parkinson-White syndrome. It is especially indicated in patients who remain symptomatic despite medical treatment [1]. Catheter ablation is generally a safe procedure with complication rates ranging from 2–5% [2]. Myocardial infarction as a complication is even less commonly reported, especially in young patients with no known risk factor for coronary artery disease [3]. This case describes the occurrence of myocardial infarction as a complication of low power ablation in a young patient.