1/62. Atypical AV nodal reentry with bystander accessory pathway: an unusual mechanism of preexcited tachycardia. We present an unusual mechanism of preexcited tachycardia--atypical AV nodal reentry with bystander AP. It can be differentiated from other preexcited tachycardias by its variable degree of preexcitation (either spontaneous or in response to atrial pacing), higher degree of preexcitation with pacing near the origin of the AP than during tachycardia, inability to preexcite the tachycardia by either late atrial or ventricular premature beats, the presence of nonpreexcited atypical AV nodal reentry tachycardia following successful AP ablation, and by exclusion of atrial tachycardia. ( info) |
2/62. Fifteen-year follow-up of a heterozygous Fabry's disease patient associated with pre-excitation syndrome. A 47-year-old woman with heterozygous Fabry's disease with pre-excitation syndrome has been followed up for 15 years. diagnosis was confirmed by the typical electron microscopic feature of the endomyocardial specimen and a decreased plasma alpha-galactosidase activity. As the disease progressed, the interventricular septum thickened from 11 to 17 mm as measured by echocardiography, while the AH interval was prolonged from 80 to 140 msec. In Fabry's disease, the PR interval has been reported to be variable from short PR to AV block. Therefore, this case may be helpful to understand the time course in the AV conduction abnormalities with the progression of Fabry's disease. ( info) |
3/62. Pre-excitation syndrome secondary to cardiac rhabdomyomas in tuberous sclerosis. Rhabdomyomas are not uncommon in infants with tuberous sclerosis. We describe a neonate who presented with hydrops fetalis arising from a tachyarrhythmia during fetal life related to rhabdomyomas. After reversion of the arrhythmia, pre-excitation was noted on an interval electrocardiogram. Following regression of the tumours, the delta wave disappeared with no further arrhythmias noted. ( info) |
4/62. False-positive exercise stress electrocardiogram due to accessory pathway in the absence of manifest preexcitation. False-positive exercise testing in patients with an accessory pathway has been described only in patients with manifest preexcitation during exercise. We describe a patient in whom marked ST-segment changes were seen during an exercise test in the absence of any preexcitation of the QRS complexes. The role of the accessory pathway in producing the ST changes was reaffirmed by absence of this abnormality following catheter ablation of the accessory pathway. ( info) |
5/62. Simultaneous transcatheter closure of an atrial septal defect with an amplatzer septal occluder and radiofrequency ablation of an accessory connection. This report describes the first case of simultaneous transcatheter closure of an atrial septal defect and radiofrequency ablation of an accessory connection. This was performed successfully on an 8-year-old boy and represents an attractive therapeutic alternative to surgical repair in this combination of relatively common cardiac conditions. ( info) |
6/62. Concealed accessory pathway manifesting clinically only after pacemaker implantation. A 66-year-old man with coronary artery disease and persistent left superior vena cava received a DDDR pacemaker for symptomatic 2:1 heart block. There was no previous history of tachyarrhythmias. Endless loop tachycardia and repetitive nonreentrant ventriculoatrial synchrony occurred afterwards and were triggered by a late coupled atrial premature beat. ECGs suggested a concealed left posterior accessory pathway that was confirmed during electrophysiological study. Effective palliation was achieved with extension of the PVARP and enabling noncompetitive atrial pacing operation. ( info) |
7/62. Late onset postpartum eclampsia without pre-eclamptic prodromi: clinical and neuroradiological presentation in two patients. In two patients eclampsia started 9 days postpartum. headache and visual disturbances preceded seizures but none of the classic pre-eclamptic signs oedema, proteinuria, and hypertension were present until shortly before seizure onset. brain herniation (patient 1) and status epilepticus (patient 2) necessitated neurointensive care management. brain MRI initially showed only frontal sulcal effacement in one patient but later showed white matter hyperintensities on T2 weighted images and a previously undescribed pattern of cortical-subcortical postgadolinium enhancement on T1 weighted images in both. Neurological deficits and MRI findings were reversed with therapy in both patients. It is concluded that late postpartum eclampsia can manifest without classic prodromi and that characteristic MRI findings may lag behind clinical manifestation. ( info) |
8/62. Familial Mahaim syndrome. We describe the occurrence of Mahaim syndrome in a mother and her son. The occurrence of such a rare disorder in two members of a family is noteworthy, has not been reported before, and suggests the possibility of genetic transmission. A genetic transmission of supraventricular tachycardia has been described only in rare cases for the wolff-parkinson-white syndrome. No such data is available for the Mahaim syndrome. ( info) |
9/62. syncope and preexcitation: a case of a Kent and fasciculoventricular Mahaim fibers. A case involving an 8-year-old girl with syncope and preexcitation on a surface electrocardiogram (ECG) that was suggestive of wolff-parkinson-white syndrome is presented. An intracardiac electrophysiologic study revealed a posteroseptal bidirectionally conducting Kent fiber. Radiofrequency ablation of the Kent fiber was successful, but the patient had a residual short His-ventricular (HV) interval and a new preexcitation pattern. Atrial extra stimuli and ventricular pacing revealed a fixed, preexcited QRS. Nodal block and loss of preexcitation was provoked with adenosine. The surface QRS and electrophysiologic features are consistent with a left septal fasciculoventricular Mahaim fiber. ( info) |
10/62. Pre-excitation with syncope: a false lead? An 18-year-old girl with pre-excitation presented with a history of recurrent syncope preceded by palpitation. The accessory pathway, which had a relatively long antegrade effective refractory period of 340 ms, was mapped and successfully ablated in the left lateral region. However, after ablation, she had reproducible sustained polymorphic ventricular tachycardia, which was found to be the cause of her syncope. Thus, alternate mechanisms of tachycardia need to be considered in patients with pre-excitation when the presentation is atypical. ( info) |