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WPW Syndrome
Ahmed El-Damaty MD Electrophysiology and Pacing Service Cardiovascular department Cairo University
WPW Syndrome Ahmed El-Damaty MD Electrophysiology and Pacing - - PowerPoint PPT Presentation
WPW Syndrome Ahmed El-Damaty MD Electrophysiology and Pacing - - PowerPoint PPT Presentation
WPW Syndrome Ahmed El-Damaty MD Electrophysiology and Pacing Service Cardiovascular department Cairo University Louis Wolf, John Parkinson and Paul White How Can WPW syndrome harm your patient? O Tachycardia O SCD AP mediated-tachycardias
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How Can WPW syndrome harm your patient?
O Tachycardia O SCD
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AP mediated-tachycardias
Bystander:
e.g SR or AT/AF
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Orthodromic AVRT
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Antidromic tachycardia
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SCD
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Risk stratifying the Asymptomatic patient
O ECG O EST O EP study
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Long term management
O Catheter based ablation is indicated for:
O Symptomatic patients O Patients who are deemed to be high risk
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Localizing APs
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ECG Localization of AP
Arruda et al. J Cardiovasc Electrophysiol. 1998 Jan;9(1):2-12
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Where is this AP?
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Where is this AP?
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35 years old gentleman with recurrent heart racing episodes
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Catheter setup
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HV
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AVRT
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Earliest activation site
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No conduction from the ventricle to the atrium
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ECG post ablation
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Accessory pathways variants
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Accessory Pathway variants
1- APs with His-Purkinji Connections: Atrio-fasicular fibres Nodo-fasicular fibres Nodo-ventricular fibres Fasiculo-ventricular fibres 2- APs with atypical course: Coronary sinus Atrial appendage to ventricle Oblique APs 3- APs associated with structural heart disease: Epstein anomaly Persistent left superior vena cava 4- Multiple APs
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Atriofasicular/ventricular fibers
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Antidromic AVRT
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Surface ECG during AVRT
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Successful ablation site of the atriofasicular variant
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His Catheter A H V A H V
FV
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His Catheter A H A V V H
Regular AP
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