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Atrial fibrillation in patients with an accessory pathway: importance of the conduction properties of the accessory pathway

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Professor Hein J.J. Wellens

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Abstract

To investigate how the electrophysiologic properties of the accessory pathway affect the occurrence of atrial fibrillation in the Wolff-Parkinson-White syndrome, programmed stimulation data of 57 patients with overt pre-excitation and 33 patients with a concealed accessory pathway with documented circus movement tachycardia were reviewed. Atrial fibrillation had occurred spontaneously in 31 (54%) of the 57 patients with the Wolff-Parkinson-White syndrome and in 1 (3%) of the 33 with a concealed accessory pathway (p< 0.001).

Sustained atrial fibrillation was induced in 23 of 31 patients with the Wolff-Parkinson-White syndrome and spontaneous atrial fibrillation (Group A), in 7 of 26 patients with the Wolff-Parkinson-White syndrome without spontaneous atrial fibrillation (Group B) and in 5 of 33 patients with a concealed accessory pathway (Group C). The anterograde effective refractory period of the accessory pathway was shorter in Group A than in Group B (252 versus 297 ms, p < 0.001). There were no differences among groups in PA interval, right to left atrium conduction time, cycle length of tachycardia and atrial and retrograde accessory pathway effective refractory period.

Atrial fibrillation is more frequent in patients with the Wolff-Parkinson-White syndrome than in those with a concealed accessory pathway. Patients with overt pre-excitation and atrial fibrillation have a shorter anterograde accessory pathway refractory period. It seems therefore that the anterograde rather than the retrograde conduction properties of the accessory pathway are the critical determinants of atrial fibrillation in the Wolff-Parkinson-White syndrome.

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Authors and Affiliations

  1. Istituto di Cardiologia, Universita’ degli Studi di Milano, Milan, Italy

    Paolo Della Bella, Mario Talajic, Robert Lemery, Pelajo Torner, Roman Lezaun, Thierry Dugernier & Hein J. J. Wellens

  2. Clinical Electrophysiology Laboratory, Academic Hospital, Maastricht, The Netherlands

    Paolo Della Bella, Mario Talajic, Robert Lemery, Pelajo Torner, Roman Lezaun, Thierry Dugernier & Hein J. J. Wellens

  3. Cardiovascular Center, O.L.V. Hospital, Aalst, Belgium

    Pedro Brugada

Authors
  1. Paolo Della Bella
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  2. Pedro Brugada
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  3. Mario Talajic
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  4. Robert Lemery
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  5. Pelajo Torner
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  6. Roman Lezaun
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Editor information

J. L. R. M. Smeets P. A. Doevendans M. E. Josephson Ch. Kirchhof M. A. Vos

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© 2000 Springer Science+Business Media Dordrecht

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Della Bella, P. et al. (2000). Atrial fibrillation in patients with an accessory pathway: importance of the conduction properties of the accessory pathway. In: Smeets, J.L.R.M., Doevendans, P.A., Josephson, M.E., Kirchhof, C., Vos, M.A. (eds) Professor Hein J.J. Wellens. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-4110-9_46

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  • DOI: https://doi.org/10.1007/978-94-011-4110-9_46

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-5799-8

  • Online ISBN: 978-94-011-4110-9

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