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Retrograde Multiple and Multifiber Accessory Pathway Conduction in the Wolff‐Parkinson‐White Syndrome:
Author(s) -
IESAKA YOSHITO,
YAMANE TEIICHI,
TAKAHASHI ATSUSHI,
GOYA MASAHIKO,
KOJIMA SHIGEYUKI,
SOEJIMA YOHKOH,
OKAMOTO YOSHIHIRO,
FUJIWARA HIDEOMI,
AONUMA KAZUTAKA,
NOGAMI AKIHIKO,
HIROE MICHIAKI,
MARUMO FUMIAKI,
HIRAOKA MASAYASU
Publication year - 1998
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.1998.tb00895.x
Subject(s) - medicine , accessory pathway , white (mutation) , cardiology , electrical conduction system of the heart , electrocardiography , atrial fibrillation , catheter ablation , genetics , biology , gene
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 underwent 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 (MP 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.