Ventriculo-atrial conduction time during reciprocating tachycardia with intermittent bundle-branch block in Wolff-Parkinson-White syndrome

Records from patients with the Wolff-Parkinson-White syndrome were reviewed with particular emphasis on the occurrence of bundle-branch block aberration during reciprocating tachycardia and the significance of this observation with respect to accessory pathway location. Increase by greater than 25 ms in the ventriculoatrial interval during reciprocating tachycardia with bundle-branch block, when compared to reciprocating tachycardia with normal intraventricular conduction, occurred only with right or left free wall accessory pathways. No patient with a septal accessory pathway proven by epicardial mapping showed a ventriculoatrial interval prolongation greater than 20 ms during bundle-branch block aberration. Measurement of ventriculo-atrial interval during bundle-branch block abe-ration also helped to diagnose accessory pathways AH and HV intervals as well as ventriculo-atrial times, may give midleading information. In one patient increase in cycle length during left bundle-branch block was the result of prolonged HV interval rather than prolonged ventriculo-atrial interval. In another patient cycle length remained the same during bundle-branch block while the ventriculo-atrial interval increased by an increment identical to the decrease in AH interval.     

Morphological studies on the human heart conduction system

An attempt has been made to demonstrate morphological equivalents of electrocardiographically determined conduction disturbances in the human heart. In 50% of our cases an authentic morphological change was found. In 25% the correlation remained doubtful, and in another 25% there was no connection. The highest coincidence was found in chronic left bundle branch block and in dissecting aneurysms causing hemopericardium. The correlation between function and morphology is very loose in patients who have undergone cardiac surgery. Etiology is discussed only marginally; ischemia is the predominant feature.     

The morphology of the myocardium in the Wolff-Parkinson-White syndrome

Myocardium of the right atrium from 5 patients with the above syndrome was studied at the light and EM level. Apoptotic degeneration of myocytes was demonstrated for the first time. The alterations observed may be secondary and due mainly to microcirculatory disturbances produced by tachyarrhythmia which appear during the excitation waves circulation. Metabolic changes and ischemization of myocytes may trigger the program of cell death (apoptosis) this aggravating the myocardium state and producing widespread fibrosis. These changes may serve a cause of lethal arrhythmia and sudden death of patients.     

Localization of angiotensin AT1 receptors in the rat heart conduction system

We characterized angiotensin II receptor subtypes in the conduction system of the rat heart using quantitative autoradiography. In both the sinoatrial and atrioventricular nodes, binding could be totally displaced by losartan, and was insensitive to PD 123177, indicating that angiotensin II receptors in the conduction system of the rat heart belong to the AT1 subtype. Angiotensin AT1 receptors could play a direct role in the regulation of the heart chronotropic properties.     

A quantitative assessment of innervation in the conduction system of the calf heart

BACKGROUND: The aim of the present investigation was to determine the relative distribution of autonomic and sensory nerves in the cardiac conduction tissues of calves. METHODS: A quantitative immunohistochemical and histochemical technique was adopted. RESULTS: Immunoreactivity to the general neuronal marker protein gene product 9.5 (PGP 9.5) demonstrated that all regions of the conduction system possessed a higher relative density of total nerves when compared with the surrounding myocardial tissues. Unlike myocardial innervation, the conduction system did not display an atrial-to-ventricular gradient in nerve density. PGP 9.5-immunoreactive nerve trunks and varicose nerve fibres were more numerous in the transitional atrioventricular node and the penetrating atrioventricular bundle than in either the sinus node, compact atrioventricular node, or bundle branches. The Purkinje network of the ventricular conduction tissues possessed a rich supply of PGP 9.5-immunoreactive nerve trunks and varicose nerve fibres. Acetylcholinesterase (AChE)-positive nerves were the main subtype identified in the sinus and atrioventricular nodes and in the ventricular conduction tissues, representing 50-80% of the area occupied by PGP 9.5-immunoreactive nerves. The compact atrioventricular node possessed AChE-positive and tyrosine hydroxylase (TH)-immunoreactive nerves in similar proportions (45%), although, in general, TH-immunoreactive nerves had a lower relative nerve density than AChE-positive nerves. Neuropeptide Y (NPY)-immunoreactive nerves represented the main peptide-containing subpopulation and occurred throughout the conduction system, displaying a similar pattern of distribution and relative density to those demonstrating TH immunoreactivity. Nerve fibres immunoreactive for somatostatin, vasoactive intestinal polypeptide, substance P, and calcitonin gene-related peptide formed relatively minor subpopulations. CONCLUSIONS: The general innervation of the bovine conduction tissues exhibits significant regional variation. Throughout all regions of the conduction system, AChE-positive nerve represented the dominant subtype when compared with TH- and NPY-immunoreactive nerves. The distribution and relative density of nerve subtypes in the tissues of the bovine conduction system are similar to those observed in man, whereas differences were observed in other regions, such as the atrioventricular bundle and bundle branches. This finding must be considered by those making interspecies comparisons.     

Surgical treatment of the paroxysmal tachycardia in Wolff-Parkinson-White syndrome

22 patients with radiolucid stones and functioning gallbladder were grouped to establish ursodeoxycholic acid efficacy (i.e. gallstones dissolution) and innocuousness for gallbladder lithiasis. Methodological aspects were detailed, the dose determined (8 and 10 mg/k/d.) and the patients evaluated after a six months' treatment. 11 patients received "day-time" doses and the other 11 "overnight" dose. Only 7 subjects turned out to be evaluated for the study of biliary lipids, to the other 15 the development of their gallstones was followed up. Successful gallstone dissolution was achieved in 8 patients (53,3%), 2 reduced size and number. 5 out of these 8 patients received "day-time" doses and the other 3 "overnight" doses. From an attendance point of view, we do not consider biliary lipids study (bile cholesterol saturation rate) to be necessary.     

Altered electrocardiogram during general anesthesia in a patient with intermittent Wolff-Parkinson-White conduction

A delta wave, which had not been detected in the preoperative electrocardiogram (ECG), was observed just before induction of anesthesia in a 53-year-old male scheduled for partial pancreatectomy. His ECG, diagnosed as intermittent Wolff-Parkinson-White (WPW) conduction, varied markedly displaying different wide QRS complexes with a short PR interval, and then returned abruptly to normal during anesthesia. WPW syndrome belongs to the category of pre-excitation syndromes, which is characterized by the accelerated abnormal conduction to the ventricle and paroxysmal tachyarrhythmias caused by an accessory pathway. We should consider the influence of anesthesia-related agents on atrioventricular conduction, and aim at preventing and managing tachyarrhythmias caused by this syndrome.     

Dissimilar atrial rhythms in a patient with the Wolff-Parkinson-White syndrome

In this report, we present the findings in a patient who had paroxysmal supraventricular tachycardia and atrial flutter associated with the Wolff-Parkinson-White syndrome. During atrial flutter, localized atrial fibrillation was recorded in the coronary sinus (dissimilar atrial rhythms), near the accessory pathway; and during 90 minutes of observation, ventricular activation occurred solely over the normal pathway. We postulate that localized atrial fibrillation repetitively invaded the accessory pathway and rendered it refractory to conduction by flutter impulses.     

Radiofrequency catheter ablation in patients with Wolff-Parkinson-White syndrome

OBJECTIVE: To report on the experience with radiofrequency catheter ablation of accessory atrioventricular pathways in patients with Wolff-Parkinson-White syndrome in terms of the duration of fluoroscopy exposure to the patient and the operator and the effect of accessory-pathway location and operator experience on the success rate. DESIGN: Retrospective review. SETTING: Tertiary care university hospital. PATIENTS: Two hundred consecutive patients with Wolff-Parkinson-White syndrome who underwent radiofrequency catheter ablation between September 1990 and June 1992. INTERVENTIONS: Electrophysiologic study and radiofrequency catheter ablation. MAIN OUTCOME MEASURES: Success rate, duration of fluoroscopy, complications and long-term follow-up. RESULTS: Of the 224 accessory pathways in the 200 patients 135 were left free wall, 47 posteroseptal, 32 right free wall and 10 anteroseptal. The overall success rate increased from 53% in the first 3 months of the study period to 96% in the last 3 months. The success rate depended on the location of the accessory pathway. The duration of fluoroscopic exposure decreased from 50 (standard deviation [SD] 21) minutes in the first 3 months to 40 (SD 15) minutes in the last 3 months (p < 0.05). Complications occurred in 3.5% of the patients; they included hemopericardium, cerebral embolism, perforation of the right atrial wall, air embolism in a coronary artery and hematoma at the arterial perforation site. None of the complications resulted in death. CONCLUSIONS: With experience, radiofrequency catheter ablation of accessory pathways can have an overall success rate of more than 95% and a complication rate of less than 4%. Such rates make this procedure suitable for first-line therapy for patients with Wolff-Parkinson-White syndrome.     

Demonstration of two anomalous bypasses in concealed Wolff-Parkinson-White syndrome

Two patients with a history of paroxysmal supraventricular tachycardia but no evidence of the Wolff-Parkinson-White syndrome in the conventional electrocardiograms were studied utilizing atrial and ventricular extrastimuli. The evidence obtained in these patients was consistent with a concealed Wolff-Parkinson-White syndrome. In one patient, ventricular extrastimuli revealed three different responses in the curve of ventriculoatrial conduction, depending upon the interval of stimulus. In the other patient, intracardiac recordings, including the left atrial potential, showed that paroxysmal supraventricular tachycardia was induced by an impulse via an anomalous bypass which diverged from the main bypass or stemmed independently from the left ventricle and was maintained by impulses via the main bypass which lay between the left ventricle and the left atrium. The mechanisms for initiation of the paroxysmal supraventricular tachycardia were discussed.     

Atrial fibrillation in Wolff-Parkinson-White syndrome. Development and therapy

In patients with Wolff-Parkinson-White syndrome the accessory pathway may participate in various tachyarrhythmias thereby influencing symptoms and prognosis. Atrial fibrillation occurs in 10 to 32% of patients and may have life-threatening consequences by precipitating ventricular fibrillation in patients with rapid conduction due to an accessory pathway with short anterograde refractory period (< 250 ms). Pathogenesis of atrial fibrillation in the WPW syndrome and therapeutic options are reviewed in this presentation. Spontaneous degeneration of atrioventricular reentrant tachycardia has been reported to represent the most frequent mode of initiation of atrial fibrillation during electrophysiologic study (up to 64% of episodes). Hemodynamic changes during tachycardia may lead to increased sympathetic tone, hypoxemia or increased tension of the atrial wall, thus, triggering atrial fibrillation. Induction of reentrant tachycardia during electrophysiologic study also has shown to be strongly correlated to its clinical prevalence and is inducible in up to 77% of patients with atrial fibrillation. The pathogenesis and high incidence of atrial fibrillation in patients with WPW syndrome is related to presence and functional properties of the accessory pathway. After surgical excision or catheter ablation more than 90% of patients are free of this arrhythmia. Anterograde conduction properties of the pathway appear to be more important than retrograde properties. High incidence of atrial fibrillation is related to short anterograde refractory periods, and of note, this arrhythmia is rare (3%) in patients with concealed pathways. With intracardiac recordings, Jackman et al. could demonstrate atrial fibrillation due to micro-reentry originating in accessory pathway networks.(ABSTRACT TRUNCATED AT 250 WORDS)     

Increased immunoexpression of atrial natriuretic peptide in the heart conduction system of the rat after cardiac sympathectomy

The present investigation was designed to elucidate which role the sympathetic nerves play in the immunoexpression of atrial natriuretic peptide in the cardiac conduction system of the rat. In order to destroy the cardiac sympathetic nerve terminals, both surgical and chemical sympathectomy were performed. By use of immunohistochemical and radioimmunoassay techniques, the immunoreactivity and level of atrial natriuretic peptide in the conduction system and in the cardiac myocardium were determined. In contrast to the low degree of immunoreaction for atrial natriuretic peptide seen in control rats, the sympathectomized rats exhibited pronounced immunoreactivity for atrial natriuretic peptide in the atrioventricular bundle and bundle branches, which normally have high numbers of sympathetic nerve fibres. On the other hand, in the peripheral parts of the conduction system, where there are ordinarily few sympathetic nerve fibres, the degree of immunoreaction was unchanged. The quantitative measurements also showed that the entire ventricles, including the conduction system, contained increased levels of atrial natriuretic peptide in the treated hearts. The present study shows that destruction of the sympathetic nervous system leads to an increased level of atrial natriuretic peptide in the Purkinje fibres of bundle branches, which thus seem to have a dormant capacity for synthesis of this peptide. The results provide new evidence about the change in atrial natriuretic peptide levels that occurs when sympathetic innervation is altered.     

Immunohistochemical study on the development of the rat heart conduction system using anti-Leu-7 antibody

Morphological aspects of the heart conduction system have been studied by various histochemical markers. However, the actual presence of markers in the conduction system and its developmental mode remain controversial. We have shown the anti-Leu-7 antibody to cross-react with cells of the rat embryonic heart conduction system by an immuno-electron microscopic study. A comparison was thus made between the results of Leu-7 immunohistochemistry and those by other markers previously used for studying the development of the conduction system. As a result, Leu-7 immunoreactivity proved the most reliable marker for studying the conduction system of the developing rat heart. Examination of the developmental mode of a rat conduction system was facilitated with the use of this marker. The immunoreactivity for Leu-7 initially appeared in the anterior wall of the bulboventricular region at 10 days of development. The development of three internodal tracts and two atrioventricular nodes was demonstrated in the following stage. These primordial atrioventricular nodes, one of which connects to a bundle of His, fused to form a single distinctive node followed by completion of the conduction system in the 18 day fetus.     

Magnesium reversal of digoxin-facilitated ventricular rate during atrial fibrillation in the Wolff-Parkinson-White syndrome

The purpose of this investigation was to determine whether pyrophosphate, the anticalculus component of tartar-control dentifrices, exerts antimicrobial activity against oral bacteria commonly found in supragingival plaque. Minimal inhibitory concentrations of pyrophosphate were determined for Streptococcus sanguis, Streptococcus mutans (serotype c), Actinomyces viscosus and Actinomyces naeslundii. All of the bacteria tested were susceptible to pyrophosphate with identical minimal inhibitory concentrations of 0.67% wt/vol (25 mM). Bactericidal kinetics assays revealed that both S. mutans and A. viscosus were killed by pyrophosphate, with the latter being considerably more susceptible. The mechanism of killing was not due to high ionic strength, as comparable controls showed no loss in numbers of viable cells. Brief exposure (two 5-min incubations) of S. mutans to pyrophosphate and sodium dodecyl sulfate caused pronounced inhibition of growth over the 24-h test period. Under the constraints of the conditions used, these studies indicate that pyrophosphate and sodium dodecyl sulfate can substantially inhibit the growth of oral bacteria. These compounds may affect the oral microflora of patients who routinely use tartar-control dentifrices and mouthrinses.     

Manifestation of the Wolff-Parkinson-White syndrome during isoprenaline infusion and carotid sinus massage

Fully susceptible cross-bred calves, six to nine months of age, were immunised by tick-induced Theileria annulata infection treated with chlortetracycline at 16 mg/kg body weight for four, eight or 16 days. The infections were induced with 10 ticks (Hyalomma anatolicum anatolicum) or 30 ticks (H dromedarii). The recovered calves were tested for immunity to homologous severe challenge, 50 or 73 days after the first infection. The reaction of the calves to infections was evaluated by noting the prepatent period, symptoms, degree of anaemia, rate of parasitisation of lymphocytes and erythrocytes. It was observed that untreated calves developed acute theileriasis characterised by typical symptoms and lesions and 56 to 66 per cent mortality. The medicated calves, however, developed a mild form of the disease. Calves which recovered from treated or untreated infections were solidly resistant to subsequent severe homologous infection. Judged from the severity of anaemia in the infected calves, eight day and 16 day medication provided slightly better protection than four day medication. It was concluded that eight day medication afforded adequate protection against the severe immunising infection, and allowed the development of solid resistance to severe homologous challenge.