Clinical and prognostic analysis of accessory pathway-induced dilated cardiomyopathy after catheter ablation in children / 中华心血管病杂志

Objective@#To investigate the clinical characteristics and prognostic factors after catheter ablation of accessory pathway (AP)-induced dilated cardiomyopathy (DCM) in children.@*Methods@#Data were collected and analyzed on 147 consecutive pediatric patients (81males and 66 females), who hospitalized in our pediatric heart center between January 2009 and August 2018 and received catheter ablation for ventricular pre-excitation (right AP). Thirty-one children were diagnosed as AP-induced DCM and 116 children with normal cardiac function served as control. Data including clinical characteristics, electrocardiogram (ECG), echocardiography, electrophysiological examination (EPS), successful ablation and follow up were analyzed.@*Results@#The median age at first examination was 3.07 (0.09, 5.83) years. The pre-hospital misdiagnosis rate was 87.1% (27/31). The incidence of the AP-induced DCM was 21.1% (31/147) and the rate of right anterior free wall accessory pathway (AP) was the highest (50.0%, 10/20). AP-induced DCM was more common in right free wall Aps (41.9%, 13/31) and right anterior free wall (32.3%, 10/31). 48.4% (15/31) cases had no supraventricular tachycardia (SVT). EPS showed that 29% (9/31) of the AP did not have retrograde conduction. The median follow-up time after successful catheter ablation was 8 (2, 36) months of AP-induced DCM group, LVDd was significantly decreased ((41.6±12.8)mm vs. (45.6±13.9)mm, P<0.01) and LVEF ((56.2±11.8)% vs. (40.8±12.5)%, P<0.01) was significantly increased after ablation. Cox regression analysis showed that LVEF was the predictor of the duration of cardiac function recovery (HR=1.08, 95%CI 1.01-1.15, P=0.03).@*Conclusions@#Misdiagnosis rate is high for children with AP-induced DCM, leading to the delayed treatment. All of the AP-induced DCM occurred in right APs and right anterior free wall APs is the highest. Right free wall APs and right anterior free wall are most common in AP-induced DCM. Catheter ablation is a safe and effective treatment option for these patients. The lower the LVEF, the longer the cardiac function recovery.

Left ventricular noncompaction and pre-excitation: an unusual finding in adults

Left ventricular noncompaction (LVNC) is a rare form of cardiomyopathy characterized by prominent left ventricular (LV) trabeculae, deep intertrabecular recesses, and the thin compacted layer. The disease is potentially associated with sudden cardiac death due to LV dysfunction and ventricular arrhythmias. The presence of accessory pathway and Wolff-Parkinson-White syndrome is particularly rare in adults. Here we describe the rare association of LVNC and ventricular pre-excitation in an 18-year-old female with neonatal hypoxic brain injury (AU)

Intermittent Pre-Excitation-Syndrome in Facio-Scapulo-Humeral Muscular Dystrophy

Pre-excitation-syndrome has not been reported as a phenotypic feature of facio-scapulo-humeral muscular dystrophy (FSH-MD). In a 39-year-old male with FSH-MD due to a reduced tandem repeat size in the D4Z4-locus on chromosome 4q35, cardiac involvement, manifesting as an incomplete right bundle-branch-block, tall T-waves in V 3-5, ST-elevation in V 2-4, and mild thickening of the left ventricular myocardium, was first recognised 10 years earlier. Follow-up at age 39 years revealed mild myocardial thickening, two intra-ventricular aberrant bands, and, surprisingly, intermittent pre-excitation on a routine electrocardiography. Cardiac involvement in FSH-MD may manifest as hypertrophic cardiomyopathy or various arrhythmias, of which one may be pre-excitation-syndrome.

The correlation between wide QRS of transesophageal atrial pacing and implicit ventricular pre-excitation / 中国基层医药

Objective To explore the correlation between wide QRS of transesophageal atrial pacing (TEAP) and implicit ventricular pre-excitation.Methods 77 patients tested by TEAP were divided into two groups according to the ECG results .45 patients in group Ⅰhad normal electrocardiogram .32 patients in group Ⅱhad ven-tricular pre-excitation.In group Ⅰ,TEAP results showed that electric pulse wave (S wave) was followed by intermit-tent or continuous wide QRS complex .At the same time , the results of group Ⅰ were compared with the results of groupⅡ.Results (1)The patients of group Ⅰwere excluded the presence of concealed accessory pathway by intra-cavitary electrocardiographic test,among them 20 patients (group ⅠA) were ventricular pacing,the test results dis-played that S wave was followed by wide QRS complex exhibiting a pattern of right bundle branch block ( RBBB) ,SR interval was 0 s;SR intervals of 25 patients (groupⅠB) were not fixed,SR interval was (0.07 ±0.01)s,S wave had no concern with QRS wave ,the wide QRS complex was premature ventricular contraction ,QRS wave shapes were dif-ferent according to the different sites of pacing origin .(2)In groupⅡ,the test results displayed that S wave was close-ly followed by the atrial depolarization wave P ,and there was a wide QRS complex with pre-excitation wave at the be-ginning after a atrioventricular conduction time shorter than normal ,SR interval was fixed ,SR interval was (0.08 ±0. 03)s,at the same time,different parts of accessory pathway QRS complex had different morphological characteristics . (3) SR interval of ⅠA group compared with groupⅠB and groupⅡ,the differences were statistically significant ( t=2.97,3.02,all P0.05).Conclusion When TEAP displaying pacing wide QRS complex ,in order to avoid bringing misdiag-nosis,TEAP results should be analyzed comprehensively rather than blindly believing that the reason was concealed accessory pathway .

Applied research of Doppler tissue imaging technique in evaluating accessory pathways in pre-excitation syndrome / 中华超声影像学杂志

Objective To evaluate the accuracy,practical value and methods of Doppler tissue imaging(DTI) in localizing the ventricular emergence site of accessory atrioventricular pathways.Methods Forty patients with pre-excitation syndrome were examined by DTI before intracardiac electrophysiologic studies(EP) and radiofrequency catheter ablation(RFCA).The pre-excitation zone was determined as a zone of maximum acceleration with “DTI acceleration mode” at the time of the delta wave or before the onset of the QRS complex.At the same time,the contraction velocity was measured from subendocardium of corresponding myocardial segment by “pulsed wave Doppler imaging”.Results Assuming the results of EP and RFCA as a gold standard,the correct localization by DTI was 80% but was only 47.5% and 52.5% by eletrocardiographic algorithms( P