Congenital and surgically acquired Wolff-Parkinson-White syndrome in patients with tricuspid atresia Alfred Hager, MD, Bernhard Zrenner, MD, Silke Brodherr-Heberlein,

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Date of download: 6/27/2016 Copyright © The American College of Cardiology. All rights reserved. From: Repetitive monomorphic ventricular tachycardia originating.

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Presentation transcript:

Congenital and surgically acquired Wolff-Parkinson-White syndrome in patients with tricuspid atresia Alfred Hager, MD, Bernhard Zrenner, MD, Silke Brodherr-Heberlein, MD, Ilse Steinbauer-Rosenthal, MD, Juergen Schreieck, MD, John Hess, MD The Journal of Thoracic and Cardiovascular Surgery Volume 130, Issue 1, Pages 48-53 (July 2005) DOI: 10.1016/j.jtcvs.2004.11.017 Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Location of the congenital accessory pathways of patients 2, 3, and 5 depicted schematically on the valvular plane. MV, Mitral valve; AoV, aortic valve, PV, pulmonary valve; D, dimple seen in the right atrium just anterior the coronary sinus ostium at the theoretic site of the atretic tricuspid valve, location of the AV node; AP 2/3/5, accessory pathway in patients 2, 3, and 5, respectively; streaked area, central fibrous body. The Journal of Thoracic and Cardiovascular Surgery 2005 130, 48-53DOI: (10.1016/j.jtcvs.2004.11.017) Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Carto mapping of patient 1 during atrial stimulation showing the right atrium and the pulmonary artery in gray. The ventricular infundibulum, surgically connected to the right atrial appendage, is color coded corresponding to timing of excitation, with red for the earliest excitation, followed by yellow, green, and blue. Two areas at the surgically created atrioinfundibular anastomosis are depicted in red as the ventricular insertion of the accessory pathways. SVC, Superior vena cava; PA, pulmonary artery; RAA, right atrial appendage; IVC, inferior vena cava. The Journal of Thoracic and Cardiovascular Surgery 2005 130, 48-53DOI: (10.1016/j.jtcvs.2004.11.017) Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 A, ECG of patient 1 during electrophysiologic study with I, II, III, v1, and v6 surface leads. MAP 1/2, Intracardiac lead near the accessory pathway showing close atrial and ventricular complexes; MAP 3/4, in the right atrial appendage showing only atrial complexes; REF, intracardiac leads across the atrioinfundibular anastomosis; REF 1/2, in the right ventricular infundibulum showing ventricular complexes; REF 3/4, at the anastomosis showing both atrial and ventricular complexes; REF 5/6 and REF 7/8, in the right atrial appendage showing only atrial complexes. B, Position of the catheters. The gray area is similar to the area of the Carto mapping of Figure 2. On the left side, orthodromic AV re-entrant tachycardia with a cycle length of 272 ms is shown. During that tachycardia, ventricular impulses are conducted back to the right atrial appendage (RAA) through a surgically acquired pathway near the tip of the mapping catheter (MAP 1/2). A single atrial premature complex induces atrial flutter and 1:1 conduction to the ventricle with a cycle length of 184 ms. Two types of ventricular complexes demonstrate either aberrancy or conduction through a second accessory pathways. SVC, Superior vena cava; PA, pulmonary artery; RV, right ventricle; IVC, inferior vena cava. The Journal of Thoracic and Cardiovascular Surgery 2005 130, 48-53DOI: (10.1016/j.jtcvs.2004.11.017) Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Intracardiac ECG of patient 3 during radiofrequency ablation. The first 2 ventricular signals show delta waves and a short PR interval of 100 ms. The following complexes depict the ECG after ablation of the accessory pathway with a narrower ventricular complex without delta wave and a normal PR interval of 160 ms. I, Surface lead; MAP1/2, tip of the mapping catheter at the accessory pathway showing signals from both the atrium and the ventricle; MAP3/4, more proximal lead of the mapping catheter in the right atrium; HRA 3/4, high right atrial lead at the right lateral wall; RVA 3/4, right ventricular apex lead; HBE 3/4, “his bundle electrode” near the AV node. The Journal of Thoracic and Cardiovascular Surgery 2005 130, 48-53DOI: (10.1016/j.jtcvs.2004.11.017) Copyright © 2005 The American Association for Thoracic Surgery Terms and Conditions