WOLFF-PARKINSON-WHITE AND OTHER PREEXCITATION SYNDROMES : simple to complex electrophysiology... and ablation of accessory pathways

This book presents the features of Wolff-Parkinson-White and other preexcitation syndromes with detailed discussion of the management and treatment of these patients. Catheter ablation has become a curative first-line treatment for circus movement tachycardias involving accessory pathway conduction. However, diagnostic and interventional challenges may be associated with anatomically and electrophysiologically complex single accessory pathway conduction, multiple accessory pathways, accessory pathways with other coexistent tachycardias, including atrioventricular nodal reentrant tachycardia and atrial tachycardias, and accessory pathways with coexistent congenital heart disease. The complexity involved requires a thorough theoretical and practical knowledge for performing unequivocally conclusive/meaningful electrophysiological testing and successful catheter ablation. This book is based on the author’s personal long-term experience and contains over 700 illustrations of intracardiac recordings and fluoroscopic images, as well as clear and user-friendly descriptions of the electrophysiologic data, its analysis and interpretation. It therefore offers a comprehensive practical guide for mapping and catheter ablation. The systematic approach is also invaluable for accessory pathways coexistent with other arrhythmias or congenital heart diseases. Wolff-Parkinson-White and Other Preexcitation Syndromes presents the topic as a fascinating part of clinical cardiac electrophysiology and all types of corresponding accessory pathways, which are often associated with diagnostic and interventional challenges. It therefore provides an invaluable educational resource to further scientific and medical knowledge in the topic and will be essential reading for all electrocardiologists and any medical professional that manages these patients. Preface Contents Characteristics, Classification, and Localization of Accessory Pathways 1 Ventricular Pre-excitation Patterns—The Wolff-Parkinson-White (WPW) and Lown-Ganong-Levine (LGL) Syndromes 1.1 Anatomical and Pathophysiological Considerations 1.2 The Wolff-Parkinson-White (WPW) Syndrome 1.2.1 Classification and Conduction Characteristics 1.2.2 Tachycardias Utilizing Atrioventricular Accessory Pathway Conduction Circus Movement Tachycardias 1.2.3 Short Decremental Atrioventricular Accessory Pathways 1.3 The Lown-Ganong-Levine (LGL) Syndrome References 2 Electrocardiographic Localization of Atrioventricular Accessory Pathways 2.1 Preexcited Electrocardiogram for Localizing Atrioventricular Accessory Pathways 2.2 Preexcited Electrocardiogram of Limited Accuracy for Identifying Pathway Location 2.2.1 Atypical Ventricular Preexcitation Unmasked in Left Free-Wall Accessory Pathways 2.2.2 Mild or Latent Ventricular Preexcitation with Limiting Accuracy for Identifying Accessory Pathways 2.3 Retrograde P Waves During Orthodromic Tachycardia Utilizing Concealed Pathways References 3 Preexcitation Patterns—Mahaim Fibres 3.1 Anatomical and Pathophysiological Considerations 3.2 Electrocardiographic Characteristics 3.2.1 Right Anterograde Atriofascicular Pathways 3.2.2 Left Posteroseptal Anterograde Atriofascicular Pathway 3.2.3 Right Posteroseptal Anterograde Nodoventricular Pathway 3.2.4 Right Concealed Nodoventricular Pathway References Electrophysiologic Study, Mapping, and Ablation of Acessory Pathways 4 Electrophysiologic Evaluation and Characteristics of Atrioventricular Accessory Pathways 4.1 Electrophysiologic Study and Methods 4.2 Electrophysiologic Characteristics of Atrioventricular Accessory Pathways 4.2.1 Baseline Recording During Sinus Rhythm 4.2.2 Programmed Atrial Stimulation During Sinus Rhythm 4.2.3 Programmed Ventricular Stimulation During Sinus Rhythm 4.2.4 Induction of Circus Movement Tachycardia 4.2.5 Programmed Stimulation During Circus Movement Tachycardia (Entrainment, Resetting) 4.2.6 Ipsilateral Bundle Branch Block During Orthodromic Circus Movement Tachycardia [32, 33] 4.2.7 Unipolar Coronary Sinus Recordings During Ventricular Stimulation and Orthodromic Circus Movement Tachycardia 4.2.8 Intravenous Adenosine for Unmasking Accessory Pathway Conduction References 5 Mapping and Ablation Approaches for Left-Sided Accessory Pathways 5.1 Retrograde Transaortic Approach from the Left Ventricular Aspect 5.2 Left Atrial Approach 5.2.1 Trans-Septal Approach 5.2.2 Retrograde Transaortic/transmitral Approach from the Left Atrial Aspect 5.3 Epicardial Approaches via the Coronary Sinus and Retrogradely from the Aortic Cusps 5.3.1 Epicardial Approach via the Coronary Sinus 5.3.2 Retrograde Approach from the Aortic Cusps References 6 Electrophysiology, Mapping, and Ablation of Atrioventricular Accessory Pathways 6.1 Mapping—Overview 6.2 Left-Sided Atrioventricular Accessory Pathways 6.2.1 Left Posterolateral, Lateral, and Anterolateral Accessory Pathways 6.2.1.1 Left Posterolateral Pathways 6.2.1.2 Left Lateral Pathways 6.2.1.3 Left Anterolateral Pathways 6.2.2 Left Posterior Accessory Pathways 6.3 Septal Atrioventricular Accessory Pathways 6.3.1 Left Posteroseptal Accessory Pathways 6.3.2 Left Midseptal Accessory Pathways 6.3.3 Right Posteroseptal Accessory Pathways 6.3.4 Right Midseptal Accessory Pathways 6.3.5 Right Anteroseptal Accessory Pathways 6.4 Right-Sided Atrioventricular Accessory Pathways 6.4.1 Right Anterior Accessory Pathways 6.4.2 Right Lateral Accessory Pathways 6.4.3 Right Posterolateral Atrioventricular Accessory Pathway References 7 Electrophysiology, Mapping and Ablation of Decremental Atrioventricular Accessory Pathways 7.1 Anterograde and Retrograde Atrioventricular Accessory Pathways 7.2 Permanent Junctional Reciprocating Tachycardia (PJRT) References Electrophysiology Study, Mapping, and Ablation of Mahaim Fibers 8 Electrophysiologic Evaluation and Characteristics of Mahaim Fibres 8.1 Electrophysiologic Study and Methods 8.2 Electrophysiologic Characteristics References 9 Electrophysiologic Study, Mapping and Ablation of Mahaim Fibres 9.1 Mapping and Catheter Ablation—Overview 9.1.1 Atriofascicular Pathways 9.1.2 Nodoventricular Pathways 9.2 Detailed Study, Mapping, and Catheter Ablation 9.2.1 Right Anterograde Atriofascicular Pathway 9.2.2 Left Anterograde Atriofascicular Pathway 9.2.3 Anterograde Right Nodoventricular Pathway 9.2.4 Concealed Right Nodoventricular Pathway 9.2.5 Concealed Right Nodofascicular Pathway References Complex Electrophysiology and Ablation 10 Latent Ventricular Preexcitation in Atrioventricular Accessory Pathways References 11 Multiple Accessory Pathways References 12 Accessory Pathways Coexistent with Atrioventricular Nodal Reentrant Tachycardia References 13 Accessory Pathways Coexistent with Atrial Tachycardia or Complicated by Atrial Fibrillation 13.1 Introduction 13.2 Accessory Pathway Coexistent with Atrial Tachycardia 13.3 Accessory Pathway Complicated by Sustained Atrial Fibrillation References 14 Accessory Pathways in Coexistent Congenital Heart Diseases 14.1 Overview 14.2 Challenges of Catheter Ablation of Accessory Pathways in Congenital Defects 14.2.1 Surgical Closure of Ventricular Septal Defect 14.2.2 Persistent Left Superior Vena Cava 14.2.3 Coronary Sinus Abnormalities 14.2.4 Ebstein’s Anomaly 14.2.5 Dextrocardia 14.2.6 Mustard Repair 14.2.7 Criss-Cross Heart 14.2.8 Repair of Tetralogy of Fallot (TOF) 14.2.9 Brugada Syndrome References 15 Troubleshooting Procedures During Ablation References Index