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Epicardial Mapping in Wolff-Parkinson-White Syndrome

Epicardial Mapping in Wolff-Parkinson-White Syndrome Abstract The syndrome of Wolff-Parkinson-White (WPW) is classically defined by an electrocardiogram with a short PR interval, a prolonged QRS complex that begins with an abnormal initial force known as the delta wave, and is seen in patients who are predisposed to tachyarrhythmias.1 Figure 1 shows the ECG of WPW compared with a normal ECG. The PR interval is short because the QRS (the delta wave) begins abnormally early in relationship to the end of the P wave. Thus, the PR interval is shortened to the same extent that the QRS is prolonged. The diagram on the right depicts atrial activation in phase 1. Phase 2 demonstrates premature ventricular excitation (preexcitation) over an accessory atrioventricular connection that conducts without the delay exhibited by the atrioventricular node. The anomalous, premature depolarization is indicated by the darker grain pattern in the heart and in the ECG. During phase 3, the ventricle is References 1. Wolff L, Parkinson J, White PD: Bundle branch block with short P-R interval in healthy young people prone to paroxysmal tachycardia. Am Heart J 5:658-704, 1930.Crossref 2. Durrer D, Roos JP: Epicardial excitation of the ventricles in a patient with Wolff-Parkinson-White syndrome type B. Circulation 35:15-21, 1967.Crossref 3. Burchell HB, Frye RL, Anderson MW, et al: Atrioventricular and ventriculoatrial excitation in Wolff-Parkinson-White syndrome (type B): Temporary ablation at surgery. Circulation 36:663-672, 1967.Crossref 4. Boineau JP, Moore EN: Evidence for propagation of activation across an accessory atrioventricular connection in types A and B pre-excitation. Circulation 41:375-397, 1970.Crossref 5. Fontaine G, Guiraudon G, Vachon J, et al: Section d'un faisceau de Kent dans un cas de syndrome de Wolff-Parkinson-White de type A-B. Arch Mal Coeur 65:905-924, 1972. 6. Boineau JP, Moore EN, Spear JF, et al: Basis of static and dynamic electrocardiographic variations in Wolff-Parkinson-White syndrome. Am J Cardiol 32:32-45, 1973.Crossref 7. Kent AFS: Illustrations of the right lateral auriculoventricular junction in the heart. J Physiol 48:63, 1914. 8. Paladino G: Contribuzione all' anatomia, istologia e fisiologia del cuore. Mov Med Chir (Napoli) 8:428-449, 1876. 9. Wood FC, Wolferth CC, Geckeler GD: Histologic demonstration of accessory muscular connections between auricle and ventricle in a case of short P-R interval and prolonged QRS complex. Am Heart J 25:454-462, 1943.Crossref 10. Ohnell RF: Pre-excitation: A cardiac abnormality. Acta Med Scand , (suppl 152) , pp 1-167, 1944. 11. Mahaim I, Clerc A: Nouvelle forme anatomique de bloc de coeur, a substituer au bloc dit d'arborisations (bloc bilateral manque). Comp Rend Soc Biol 109:183, 1932. 12. Lev M, Gibson S, Miller RA: Ebstein's disease with Wolff-Parkinson-White syndrome. Am Heart J 49:724-741, 1955.Crossref 13. James TN: Morphology of the human atrioventricular node with remarks pertinent to its electrophysiology. Am Heart J 62:756-771, 1961.Crossref 14. Castellanous A Jr, Chapunoff E, Castillo C, et al: His bundle electrograms in two cases of Wolff-Parkinson-White (pre-excitation) syndrome. Circulation 41:399-411, 1970.Crossref 15. Lown B, Ganong WF, Levine SA: The syndrome of short PR interval, normal QRS complex and paroxysmal rapid heart action. Circulation 5:693-706, 1952.Crossref 16. Sealy WC, Boineau JP, Wallace AG: The identification and division of the bundle of Kent for premature ventricular excitation and supraventricular tachycardia. Surgery 68:1009-1017, 1970. 17. Sealy WC, Wallace AG, Ramming KP, et al: An improved operation for the definitive treatment of the Wolff-Parkinson-White syndrome. Ann Thorac Surg 17:107-113, 1974.Crossref 18. Sealy WC, Wallace AG: Surgical treatment of Wolff-Parkinson-White syndrome. J Thorac Cardiovasc Surg 68:757-770, 1974. 19. Svenson RH, Gallagher JJ, Sealy WC, et al: An electrophysiologic approach to the surgical treatment of the Wolff-Parkinson-White syndrome: Report of two cases utilizing catheter recording and epicardial mapping techniques. Circulation 49:799-804, 1974.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Epicardial Mapping in Wolff-Parkinson-White Syndrome

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Publisher
American Medical Association
Copyright
Copyright © 1975 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1975.00330030072008
Publisher site
See Article on Publisher Site

Abstract

Abstract The syndrome of Wolff-Parkinson-White (WPW) is classically defined by an electrocardiogram with a short PR interval, a prolonged QRS complex that begins with an abnormal initial force known as the delta wave, and is seen in patients who are predisposed to tachyarrhythmias.1 Figure 1 shows the ECG of WPW compared with a normal ECG. The PR interval is short because the QRS (the delta wave) begins abnormally early in relationship to the end of the P wave. Thus, the PR interval is shortened to the same extent that the QRS is prolonged. The diagram on the right depicts atrial activation in phase 1. Phase 2 demonstrates premature ventricular excitation (preexcitation) over an accessory atrioventricular connection that conducts without the delay exhibited by the atrioventricular node. The anomalous, premature depolarization is indicated by the darker grain pattern in the heart and in the ECG. During phase 3, the ventricle is References 1. Wolff L, Parkinson J, White PD: Bundle branch block with short P-R interval in healthy young people prone to paroxysmal tachycardia. Am Heart J 5:658-704, 1930.Crossref 2. Durrer D, Roos JP: Epicardial excitation of the ventricles in a patient with Wolff-Parkinson-White syndrome type B. Circulation 35:15-21, 1967.Crossref 3. Burchell HB, Frye RL, Anderson MW, et al: Atrioventricular and ventriculoatrial excitation in Wolff-Parkinson-White syndrome (type B): Temporary ablation at surgery. Circulation 36:663-672, 1967.Crossref 4. Boineau JP, Moore EN: Evidence for propagation of activation across an accessory atrioventricular connection in types A and B pre-excitation. Circulation 41:375-397, 1970.Crossref 5. Fontaine G, Guiraudon G, Vachon J, et al: Section d'un faisceau de Kent dans un cas de syndrome de Wolff-Parkinson-White de type A-B. Arch Mal Coeur 65:905-924, 1972. 6. Boineau JP, Moore EN, Spear JF, et al: Basis of static and dynamic electrocardiographic variations in Wolff-Parkinson-White syndrome. Am J Cardiol 32:32-45, 1973.Crossref 7. Kent AFS: Illustrations of the right lateral auriculoventricular junction in the heart. J Physiol 48:63, 1914. 8. Paladino G: Contribuzione all' anatomia, istologia e fisiologia del cuore. Mov Med Chir (Napoli) 8:428-449, 1876. 9. Wood FC, Wolferth CC, Geckeler GD: Histologic demonstration of accessory muscular connections between auricle and ventricle in a case of short P-R interval and prolonged QRS complex. Am Heart J 25:454-462, 1943.Crossref 10. Ohnell RF: Pre-excitation: A cardiac abnormality. Acta Med Scand , (suppl 152) , pp 1-167, 1944. 11. Mahaim I, Clerc A: Nouvelle forme anatomique de bloc de coeur, a substituer au bloc dit d'arborisations (bloc bilateral manque). Comp Rend Soc Biol 109:183, 1932. 12. Lev M, Gibson S, Miller RA: Ebstein's disease with Wolff-Parkinson-White syndrome. Am Heart J 49:724-741, 1955.Crossref 13. James TN: Morphology of the human atrioventricular node with remarks pertinent to its electrophysiology. Am Heart J 62:756-771, 1961.Crossref 14. Castellanous A Jr, Chapunoff E, Castillo C, et al: His bundle electrograms in two cases of Wolff-Parkinson-White (pre-excitation) syndrome. Circulation 41:399-411, 1970.Crossref 15. Lown B, Ganong WF, Levine SA: The syndrome of short PR interval, normal QRS complex and paroxysmal rapid heart action. Circulation 5:693-706, 1952.Crossref 16. Sealy WC, Boineau JP, Wallace AG: The identification and division of the bundle of Kent for premature ventricular excitation and supraventricular tachycardia. Surgery 68:1009-1017, 1970. 17. Sealy WC, Wallace AG, Ramming KP, et al: An improved operation for the definitive treatment of the Wolff-Parkinson-White syndrome. Ann Thorac Surg 17:107-113, 1974.Crossref 18. Sealy WC, Wallace AG: Surgical treatment of Wolff-Parkinson-White syndrome. J Thorac Cardiovasc Surg 68:757-770, 1974. 19. Svenson RH, Gallagher JJ, Sealy WC, et al: An electrophysiologic approach to the surgical treatment of the Wolff-Parkinson-White syndrome: Report of two cases utilizing catheter recording and epicardial mapping techniques. Circulation 49:799-804, 1974.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Mar 1, 1975

References