Missing diagnosis of preexcitation syndrome on ECG: Clinical and electrophysiological significance

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• 作者：Bé ; atrice Brembilla-Perrot ; ^{b.brembilla-perrot@chu-nancy.fr} ; Rouzbeh Valizadeh Moejezi ; Pierre Yves Zinzius ; Soumaya Jarmouni ; Jé ; rô ; me Schwartz ; Daniel Beurrier ; Jean Marc Sellal ; Ibrahim Nossier ; Lucian Muresan ; Marius Andronache ; Radou Moisei ; Olivier Selton ; Pierre Louis ; Arnaud Terrier de la Chaise
• 关键词：Wolff&ndash ; Parkinson&ndash ; White syndrome ; ECG ; Electrophysiology ; Prognosis
• 刊名：International Journal of Cardiology
• 出版年：2013
• 出版时间：10 March, 2013
• 年：2013
• 卷：163
• 期：3
• 页码：288-293
• 全文大小：1259 K

文摘

Electrocardiographic criteria of preexcitation syndrome are sometimes not visible on ECG in sinus rhythm (SR). The purpose of the study was to evaluate the significance of unapparent preexcitation syndrome in SR, when overt conduction through accessory pathway (AP) was noted at atrial pacing.

Methods

Anterograde conduction through atrioventricular AP was identified at electrophysiological study (EPS) in 712 patients, studied for tachycardia (n = 316), syncope (n = 89) or life-threatening arrhythmia (n = 55) or asymptomatic preexcitation syndrome (n = 252). ECG in SR at the time of EPS was analysed.

Results

78 patients (11 % ) (group I) had a normal ECG in SR and anterograde conduction over AP at atrial pacing; 634 (group II) had overt preexcitation in SR. Group I was as frequently asymptomatic (35 % ) as group II (35 % ), had as frequently tachycardias, syncope or life-threatening arrhythmia as group II (43, 5, 2 % vs 43, 13, 8 % ). AP was more frequently left lateral in group I (57 % ) than in group II (36 % )(p < 0.001). AV re-entrant tachycardia, atrial fibrillation (AF), antidromic tachycardia were induced as frequently in group I (54, 18, 10 % ) as in group II (54, 27, 7 % ). Malignant forms (induced AF with RR intervals between preexcited beats < 250 ms in control state or < 200 ms after isoproterenol) were as frequent in group I (11.5 % ) as II (14 % ).

Conclusions

The frequency of unapparent preexcitation syndrome represents 11 % of our population with anterograde conduction through an AP and could be underestimated. The risk to have a malignant form is as high as in patients with overt preexcitation syndrome in SR.