Circulation, Vol 72, 161-169, Copyright © 1985 by American Heart Association
AD Sharma, GJ Klein, GM Guiraudon and S Milstein
The effect of surgical ablation of ablation of atrioventricular accessory
pathways on the incidence of atrial fibrillation in patients with
Wolff-Parkinson-White syndrome was examined and the results of preoperative
electrophysiologic testing were studied to determine factors predictive of
outcome. Among 50 consecutive surgical cases, 19 patients were identified
with a past history of at least one episode of spontaneous atrial
fibrillation documented by electrocardiogram before surgery. The mean
number of episodes of atrial fibrillation was 1.97/patient/year during a
mean symptomatic period of 6.9 years before surgery. These patients were
compared with 19 consecutive patients undergoing surgery during the same
time period who had a history of only reciprocating tachycardia. Patients
with atrial fibrillation had a significantly shorter antegrade accessory
pathway effective refractory period (270 +/- 39 vs 330 +/- 107 msec; p less
than .05) and much faster ventricular rates during induced atrial
fibrillation (shortest RR interval 219 +/- 73 vs 294 +/- 60 msec, p less
than .005; average RR interval 324 +/- 109 vs 405 +/- 127 msec, p less than
.01). Patients with atrial fibrillation also had longer PA intervals (47
+/- 13 vs 37 +/- 7 msec; p less than .02). At preoperative
electrophysiologic testing, 18 patients with atrial fibrillation had atrial
fibrillation induced and 14 sustained the arrhythmia for longer than 10
min. In contrast, atrial fibrillation, although induced in 14 of 19
patients with reciprocating tachycardia, was not sustained in any. Thus
electrophysiologic testing suggested that both accessory pathway properties
and atrial vulnerability may predispose to atrial fibrillation.(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
Atrial fibrillation in patients with Wolff-Parkinson-White syndrome: incidence after surgical ablation of the accessory pathway
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