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- Title
Retrograde Multiple and Multifiber Accessory Pathways Conduction in the Wolff-- Parkinson-- White Syndrome: Potential Precpitating Factor of Atrial Fibrillation.
- Authors
Iesaka, Yoshito; Yamane, Teiichi; Takahashi, Atsushi; Goya, Masahiko; Kojima, Shigeyiki; SoejIma, Yohkoh; Okamoto, Yoshihiro; Fujiwara, Hideomi; Aonuma, Kazutaka; Nogami, Akihiko; Hiroe, Michiaki; Marumo, Fumiaki; Hiraoka, Masayasu
- Abstract
Retrograde Multiple Accessory Pathway Precipitating AF. Introduction: The determinants of susceptibility to atrial fibrillation (AF) and the existence of accessory pathway conduction have remained unidentified in the Wolff-Parkinson-White (WPW) syndrome. We tested the hypothesis that excitation inputs into the atrium over a retrograde multiple or multifiber accessory pathway during AV reentrant tachycardia (AVRT) could precipitate initiation of AF. Methods and Results: Two hundred fifty consecutive patients with WPW syndrome under-went electrophysiologic study and radiofrequency catheter ablation. The patients were classified into two groups according to the study results: 29 with retrograde multiple or multifiber accessory pathway (MP) and 221 with retrograde single accessory pathway (SP). Compared with the SP patients, the MP patients showed a significantly higher incidence of clinical AF (MP vs SP: 19/29 vs 51/221, P < 0.01), induced AF (12/29 vs 32/221, P < 0.01), and initiated AF during ventricular pacing and AVRT (10/12 vs 17/32, P < 0.05). There were no differences between the two groups in incidence of clinical and induced AVRT (24/29 vs 200/221 and 25/29 vs 206/221, respectively), mean cycle length of induced AVRT, or electrophysiologic parameters of the accessory pathway. AF inducibility during AVRT or ventricular pacing was eliminated by partial ablation in 7 of 10 patients with MP. After total ablation, the incidence of induced AF was similar between the two groups (MV vs SP: 1/29 vs 11/221). Conclusion: The existence of a retrograde multiple or multifiber accessory pathway in patients with WPW syndrome is associated with a higher incidence of clinical and induced AF. Successful ablation of the retrograde multiple or multifiber accessory pathway can eliminate the induction of both AVRT and AF.
- Subjects
WOLFF-Parkinson-White syndrome; ATRIAL fibrillation; TACHYCARDIA; ELECTROPHYSIOLOGY; ATRIAL arrhythmias; ARRHYTHMIA
- Publication
Journal of Cardiovascular Electrophysiology, 1998, Vol 9, Issue 2, p141
- ISSN
1045-3873
- Publication type
Article
- DOI
10.1111/j.1540-8167.1998.tb00895.x