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Wolff-Parkinson-White syndrome: where is the pathway?

Turakhia MP, Scheinman M, Badhwar N - Indian Pacing Electrophysiol J (2009)

Bottom Line: The earliest local activation was seen in the true coronary sinus lumen at the bifurcation of the posterolateral branch.Radiofrequency energy application at this area led to loss of preexcitation.Therefore, investigation of the coronary sinus and its branches may allow for effective ablation without the need for left ventricular access.

View Article: PubMed Central - PubMed

Affiliation: Electrophysiology Section, Department of Medicine, Stanford University. mintu@stanford.edu

ABSTRACT
A 31-year old male presented with atrial fibrillation and ventricular preexcitation that was positive in leads V1-V4, negative in lead II, and positive in lead AVR. The patient was cardioverted and invasive electrophysiologic study was performed. Based on the ECG findings, the coronary sinus and its branches were interrogated during orthodromic atrioventricular reentrant tachycardia. The earliest local activation was seen in the true coronary sinus lumen at the bifurcation of the posterolateral branch. Radiofrequency energy application at this area led to loss of preexcitation. When localizing left septal and posterior accessory pathways, ventricular preexcitation that is both negative in II and positive in AVR has been shown in previous studies to be highly sensitive and specific for a subepicardial location. Therefore, investigation of the coronary sinus and its branches may allow for effective ablation without the need for left ventricular access.

No MeSH data available.


Related in: MedlinePlus

Electrocardiogram before (1A) and after (1B) electrical cardioversion
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Figure 1: Electrocardiogram before (1A) and after (1B) electrical cardioversion

Mentions: A 31-year old male presented to the emergency room with palpitations. The electrocardiogram (ECG) showed atrial fibrillation with preexcitation (Figure 1A). After electrical cardioversion, there was evidence of preexcitation in sinus rhythm (Figure 1B). Invasive electrophysiology study was performed, which confirmed the presence of a single accessory pathway. What is the most likely site of the pathway, and from where should you start to map?


Wolff-Parkinson-White syndrome: where is the pathway?

Turakhia MP, Scheinman M, Badhwar N - Indian Pacing Electrophysiol J (2009)

Electrocardiogram before (1A) and after (1B) electrical cardioversion
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2655076&req=5

Figure 1: Electrocardiogram before (1A) and after (1B) electrical cardioversion
Mentions: A 31-year old male presented to the emergency room with palpitations. The electrocardiogram (ECG) showed atrial fibrillation with preexcitation (Figure 1A). After electrical cardioversion, there was evidence of preexcitation in sinus rhythm (Figure 1B). Invasive electrophysiology study was performed, which confirmed the presence of a single accessory pathway. What is the most likely site of the pathway, and from where should you start to map?

Bottom Line: The earliest local activation was seen in the true coronary sinus lumen at the bifurcation of the posterolateral branch.Radiofrequency energy application at this area led to loss of preexcitation.Therefore, investigation of the coronary sinus and its branches may allow for effective ablation without the need for left ventricular access.

View Article: PubMed Central - PubMed

Affiliation: Electrophysiology Section, Department of Medicine, Stanford University. mintu@stanford.edu

ABSTRACT
A 31-year old male presented with atrial fibrillation and ventricular preexcitation that was positive in leads V1-V4, negative in lead II, and positive in lead AVR. The patient was cardioverted and invasive electrophysiologic study was performed. Based on the ECG findings, the coronary sinus and its branches were interrogated during orthodromic atrioventricular reentrant tachycardia. The earliest local activation was seen in the true coronary sinus lumen at the bifurcation of the posterolateral branch. Radiofrequency energy application at this area led to loss of preexcitation. When localizing left septal and posterior accessory pathways, ventricular preexcitation that is both negative in II and positive in AVR has been shown in previous studies to be highly sensitive and specific for a subepicardial location. Therefore, investigation of the coronary sinus and its branches may allow for effective ablation without the need for left ventricular access.

No MeSH data available.


Related in: MedlinePlus