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The Management of Patients with Suspected Wolff‐Parkinson‐White Syndrome—A Four Year Review
Author(s) -
Hamer A. W. F.,
Vohra J. K.,
Sloman J. G.,
Hunt D.
Publication year - 1981
Publication title -
australian and new zealand journal of medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 0004-8291
DOI - 10.1111/j.1445-5994.1981.tb03537.x
Subject(s) - medicine , asymptomatic , supraventricular tachycardia , atrial fibrillation , medical therapy , tachycardia , pharmacotherapy , refractory (planetary science) , cardiology , surgery , physics , astrobiology
Thirty‐six patients with the electrocardiographic pattern of Wolff‐Parkinson‐White (WPW) Syndrome had electrophysiological (EP) studies over a four year period. Thirty‐two patients were symptomatic and supraventricular tachycardia (SVT) or atrial fibrillation (A Fib) had been demonstrated in 19 of these patients. Four patients were asymptomatic . The diagnosis of WPW was confirmed in 33 of the 36 patients at EP studies and in 24 of 33 the location of the accessory atrioventricular connection (AAVC) from the surface ECG was confirmed at EP studies. The effective refractory period of the AAVC in 30 patients ranged from 200–550 ms (m 284 ± 58 ms). A Fib could be induced in 20 of the 32 patients and SVT in 21 of the 33 patients. In 14 of 21 patients the SVT had narrow QRS complexes; in three patients the QRS was wide and in four patients both types were noted. In three patients the diagnosis of WPW was disproved at EP studies . On the basis of EP studies, drug therapy was recommended in 21 patients. In 12 of the 21 patients previous drug therapy was changed. Nine of these 12 patients showed symptomatic improvement. Of the remaining patients one required surgery because of failed medical treatment; the two other patients died and their deaths could be attributed to failure of medical therapy. In seven patients no change was made in drug therapy and in two, intermittent drug therapy was recommended. In six patients no drug therapy was prescribed . Two patients were treated with magnetactivated implantable pacemakers capable of delivering coupled, fixed‐interval right ventricular extrastimuli. Neither of these was successful and thus surgery was recommended. Six patients have undergone surgical section of their AAVC with complete control of tachycardia; two patients are awaiting surgery . EP studies were helpful in the management of the majority of symptomatic patients with suspected WPW Syndrome. Surgery offers an attractive alternative to long term, and occasionally unsuccessful, drug therapy and should be considered in suitable patients .