[Recurrent attacks of antidromic tachycardia in a patient with WPW syndrome and latent accessory pathway A-V conduction]. / Uporczywe napady czestoskurczu antydromowego u chorego z jawnym zespolem WPW i utajonym dodatkowym szlakiem przewodzenia A-V.

A case of a 38 year old male with WPW syndrome and frequently recurrent antidromic atrio-ventricular sustained tachycardias is presented. In his ecg recordings delta wave depolarizations indicated right free wall accessory pathway. This was proved during electrophysiologic study. The effective refractory period of this pathway was short in both directions-below 200 ms. There was a wide zone of sustained antidromic tachycardia 236-247/min induction. Intravenous injection of flecainide terminated antidromic tachycardia but a wide zone of sustained orthodromic tachycardia 150/min induction appeared. Dissection of the right free wall accessory pathway was performed using Sealy technique (Cox modification). During the intraoperation electrophysiologic study an orthodromic tachycardia with retrograde conduction through an antero-septal accessory pathway was induced. After dissection of that second pathway abnormal atrioventricular conduction was abolished. The patients has been free from episodes of tachycardia during one year follow-up period.

[2 episodes of ventricular fibrillation in a patient with mild paroxysms of Wolff-Parkinson-White syndrome]. / Dwukrotne migotanie komór u chorego z lagodnymi napadami czestoskurczu przedsionkowo-komorowego.

In a patient with an overt Wolff-Parkinson-White syndrome and short paroxysms of atrio-ventricular tachycardia, episodes of atrial fibrillation occurred twice at age of 21 and 24. Atrial fibrillation degenerated into ventricular fibrillation. Intravenous injection of verapamil in this patient (with a short refractory period of the accessory pathway) could have facilitated ventricular fibrillation. The patient was resuscitated successfully. Electrophysiologic study revealed double accessory pathways--in the left free wall (effective refractory period in both directions--below 200 ms) and right posterior ++para-septal localization. 20th Nov 1990 A. Biederman M.D. performed surgical dissection of both accessory pathways. In control electrophysiologic studies there was no evidence of abnormal atrio-ventricular conduction. During one year follow up the patient reported no paroxysms of tachycardia.

[Early results of surgical treatment of patients with Wolff-Parkinson-White syndrome]. / Wczesne wyniki leczenia operacyjnego chorych z zespolem Wolff-Parkinson-White'a.

Successful dissection of accessory pathways (AcP's) was performed in 19 of 20 patients. 15 pts had single, 4 double and 1 patient had 3 accessory pathways (AcP's). The patient with 3 AcP's was operated twice. During the first operation two AcP's were eliminated. The third one was revealed during the postoperative electrophysiologic study. Verapamil facilitated its manifestation and localisation. No patient had syncope or atrio-ventricular tachycardia after the operation. In 3 of 10 patients who had atrial fibrillation before the operation, episodes of AF occurred in the early postoperative period. Conduction to the ventricles was through the normal conduction system. Dissection of AcP's prevented extremely fast ventricular response and syncope. After discontinuation of amiodarone more frequent ventricular premature beats occurred in patients with long history of cardiac arrhythmias, on drugs for a long time and in patients who had heart dilatation. Several months after the operation VEB were less frequent, probably because tachycardias did not occur, left ventricle geometry improved, and cardiodepressant drugs were discontinued. Previously these patients had been treated usually with combination of 2-3 such drugs. After the successful dissection of AcP's the patients lost the feeling of illness and do not feel being imperilled. Children can attend schools normally and some adult patients resumed their professional activities.

[Emergency epicardial dissection of the accessory pathway in a patient with atrioventricular nodal reentrant tachycardia]. / Przeciecie dodatkowego szlaku przewodzenia w trybie pilnym u chorego z uporczywym czestoskurczem przedsionkowo-komorowym.

Diagnostic and therapeutic problems in 14 year old patient with concealed WPW syndrome were presented. Paroxysms of atrio-ventricular reentrant tachycardia 180-220/min were frequently recurring, usually with normal QRS pattern. Tachycardias often had to be terminated by intravenous administration of antiarrhythmic drugs. Long term treatment with various antiarrhythmic agents did not prevent recurrence of tachycardias but they became sustained and were recurring more often. Their other side effects manifested with sinus node disfunction and depression of the heart muscle. The electrophysiologic study revealed right anterior septal accessory pathway. Epicardial dissection of the accessory pathway was urgently performed. The control electrophysiologic study revealed no evidence of conduction through the accessory pathway. The patient did not require antiarrhythmic treatment. During the 12 months follow up no tachycardia occurred.