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Features of accessory pathways in adult Ebstein's anomaly

Published on Nov 1, 2014in Europace6.10
· DOI :10.1093/europace/euu028
Wei Wei5
Estimated H-index: 5
(Guangdong General Hospital),
Xianzhang Zhan6
Estimated H-index: 6
(Guangdong General Hospital)
+ 5 AuthorsShulin Wu9
Estimated H-index: 9
(Guangdong General Hospital)
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Abstract
Aims The aim of the study was to describe the complex electrophysiological features of accessory pathways (APs) in adult Ebstein's anomaly (EA). Methods and results We performed a retrospective study of 17 consecutive adult EA cases with APs who underwent electrophysiological study and radiofrequency catheter ablation (RFCA) from November 2011 to May 2013. There were a total of 24 atrioventricular reentrant tachycardias (AVRTs) due to 23 APs, including 20 (87.0%) non-decremental conducting, 2 (8.7%) decremental conducting, and 1 (4.3%) nodofascicular bundle. Six (6/17 = 35.3%) patients had two APs while others had only one. Twenty-one APs (91.3%) in 15 patients were manifested and 2 APs (8.7%) in 2 patients were concealed. Six APs (26.1%) were broad, while 17 APs (73.9%) were narrow in width. Two patients suffered from duodromic tachycardias mediated by two APs. Accessory pathways were mainly located on the posterior, posteroseptal, and posterolateral tricuspid annulus (TA). Right ventriculography confirmed that all APs were located on the anatomic TA. All the patients remained free from tachycardias during 11.9 ± 6.8 months of follow-up after RFCA. For the 15 patients with manifest APs, 10 patients' electrocardiograms (ECGs) after RFCA demonstrated morphologies of right bundle branch block, while 5 patients' ECGs were normal. Conclusions Accessory pathways in EA are predominantly right-sided, manifest and localize to the lower half of the anatomic TA. A number of APs in EA have broad widths. The incidence of multiple APs is high in these patients and RFCA is effective.
  • References (19)
  • Citations (17)
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References19
Newest
Published on Feb 1, 2013in Cardiology in The Young0.94
Angela Oxenius5
Estimated H-index: 5
(Boston Children's Hospital),
Christine H. Attenhofer Jost21
Estimated H-index: 21
+ 6 AuthorsEmanuela R. Valsangiacomo Buechel17
Estimated H-index: 17
(Boston Children's Hospital)
OBJECTIVES: To assess clinical presentation, treatment, and outcome of children with Ebstein's anomaly. BACKGROUND: Data on long-term outcome of children with Ebstein's anomaly are scarce. METHODS: Retrospective analysis of all children with Ebstein's anomaly treated between February, 1979 and January, 2009 in a single tertiary institution. Primary outcomes included patient survival and need for intervention, either cardiac surgery or catheter intervention. RESULTS: A total of 42 patients were d...
Published on Oct 1, 2012in Chinese Medical Journal1.55
Yingyong Hou13
Estimated H-index: 13
,
Fang Ph1
Estimated H-index: 1
+ 5 AuthorsShuyang Zhang10
Estimated H-index: 10
Published on Dec 1, 2011in Journal of Cardiovascular Electrophysiology2.91
Laurent Roten3
Estimated H-index: 3
(University of Bern),
Peter Lukac1
Estimated H-index: 1
+ 5 AuthorsEtienne Delacretaz2
Estimated H-index: 2
(University of Bern)
In patients with Ebstein's anomaly (EA) arrhythmias are frequently encountered. Although most arrhythmias can be targeted with catheter ablation, specific issues render the procedure more challenging in EA. This study examines the mechanisms of the different arrhythmias related to EA and the outcome after catheter ablation.
Published on May 1, 2008in Cardiovascular Pathology1.76
David W. Barbara10
Estimated H-index: 10
(Mayo Clinic),
William D. Edwards96
Estimated H-index: 96
(Mayo Clinic)
+ 1 AuthorsJoseph A. Dearani69
Estimated H-index: 69
(Mayo Clinic)
Abstract Background Ebstein's anomaly has been described extensively in autopsy material. However, there have been no large surgical pathology series of this malformation. Objective To review clinical and surgical pathologic features of a large number of cases of Ebstein's anomaly from a single institution. Methods Review of medical histories, surgical reports, and surgical pathology reports at the Mayo Clinic (2000–2005). Results Among 104 patients, the mean age was 31 years (2 months–79 years)...
Published on Feb 1, 2008in Heart5.08
Soizic Paranon6
Estimated H-index: 6
,
Philippe Acar27
Estimated H-index: 27
Ebstein’s anomaly was first described by Wilhelm Ebstein in 1866. At autopsy of a young man with a history of palpitations’ and dyspnoea followed—before his death—by cyanosis, cardiomegaly and systolic murmur, the Berlin based doctor described a tricuspid valve abnormality. This congenital malformation is characterised by any degree of inferior displacement of the proximal attachments of the septal and posterior leaflets of the tricuspid valve from the atrioventricular ring. It occurs in about 1...
Published on Aug 1, 2007in The Annals of Thoracic Surgery3.92
Christopher J. Knott-Craig25
Estimated H-index: 25
(University of Oklahoma Health Sciences Center),
Steven P. Goldberg8
Estimated H-index: 8
(UAB: University of Alabama at Birmingham)
+ 2 AuthorsJames K. Kirklin67
Estimated H-index: 67
(UAB: University of Alabama at Birmingham)
Background Severely symptomatic neonates and young infants with Ebstein's anomaly usually die without surgical intervention. The relative risks and benefits of single-ventricle palliation versus a two-ventricle repair are uncertain. In a recent series, 69% early survival with single-ventricle palliation was reported in 16 neonates with Ebstein's anomaly. Our institutional bias has been to do a two-ventricle repair in all such patients. Methods We reviewed our entire surgical experience with a tw...
Published on Jun 26, 2007in Circulation23.05
Edward P. Walsh65
Estimated H-index: 65
(Boston Children's Hospital)
“The treatment of congenital heart disease is unsatisfactory. As a rule, nothing can be done to improve patients symptomatically; in some instances digitalis may be of help.” — —L. Emmett Holt, MD, 1933 On August 26, 1938, Dr Robert Gross performed the first successful surgery for a congenital heart defect by closing a patent ductus arteriosus in a 7-year-old girl. The event marked the beginning of an interventional approach to congenital heart disease (CHD) that forever banished the sort of pes...
Published on Jan 1, 2007in International Journal of Cardiology3.47
Thomas J. Kiernan1
Estimated H-index: 1
(BlackRock),
Gerry Fahy1
Estimated H-index: 1
(BlackRock)
Ebstein's anomaly is a rare congenital cardiac disease initially described by Wilhelm Ebstein in 1866. The primary pathology involves significant apical displacement of the septal tricuspid valve leaflet and the presence of a redundant, elongated, anterior tricuspid valve leaflet. This congenital malformation has multiple known associated morphological and electrophysiological cardiac pathologies. In the present article, we report, to the best of our knowledge for the first time in the literatur...
Published on Dec 1, 2006in Journal of Cardiovascular Electrophysiology2.91
Pedro Iturralde1
Estimated H-index: 1
,
Santiago Nava2
Estimated H-index: 2
+ 6 AuthorsMario D. Gonzalez1
Estimated H-index: 1
(UF: University of Florida)
UNLABELLED The abnormal development of the tricuspid valve in patients with Ebstein's anomaly results in several activation abnormalities including delayed intraatrial conduction, right bundle branch block (RBBB), and ventricular preexcitation. The aim of the present study was to define the ECG characteristics before and after ablation of an accessory A-V pathway (AP) in patients with Ebstein's anomaly. METHODS A series of 226 consecutive patients with Ebstein's anomaly was studied. Sixty-four p...
Published on Jul 1, 2006in Journal of Cardiovascular Electrophysiology2.91
Yaniv Bar-Cohen15
Estimated H-index: 15
,
Paul Khairy55
Estimated H-index: 55
+ 3 AuthorsCharles I. Berul58
Estimated H-index: 58
Wolff-Parkinson-White syndrome. Introduction: ECG algorithms used to localize accessory pathways (AP) in patients with Wolff-Parkinson-White (WPW) syndrome have been validated in adults, but less is known of their use in children, especially in patients with congenital heart disease (CHD). We hypothesize that these algorithms have low diagnostic accuracy in children and even lower in those with CHD. Methods: Pre-excited ECGs in 43 patients with WPW and CHD (median age 5.4 years [0.9-32 years]) w...
Cited By17
Newest
Published on 2019in IJC Heart & Vasculature
Raúl A Montañez-Valverde (UNMSM: National University of San Marcos), Luis Alberto More (Universidad de San Martín de Porres), Pablo Mendoza-Novoa (Mayo Clinic)
Abstract Background In 2015, the Ministry of Health (MINSA) of Peru inaugurated the first national center for electrophysiology studies in a public tertiary referral hospital with the purpose to provide healthcare access to the most underserved population. This study aims to describe the rate of success and complications of catheter ablation in this center since its inception, as well as the demographic characteristics of these patients. Methods This study is descriptive and retrospective. We us...
Published on Jul 8, 2019in Journal of Arrhythmia
Jae-Sun Uhm16
Estimated H-index: 16
(Yonsei University),
Jun Kim9
Estimated H-index: 9
(UOU: University of Ulsan)
+ 12 AuthorsPak Hui-Nam31
Estimated H-index: 31
(Yonsei University)
Published on Jul 1, 2019in Canadian Journal of Cardiology5.59
Paul Khairy55
Estimated H-index: 55
(MHI: Montreal Heart Institute)
Abstract The expanding population of adults with congenital heart disease (CHD) combined with the pervasiveness of arrhythmias has resulted in the rapid growth of a dedicated sector of cardiology at the intersection between two subspecialties: electrophysiology and adult CHD. Herein, practical considerations are offered regarding urgent referral for catheter ablation of atrial arrhythmias, anticoagulation, and primary prevention implantable cardioverter-defibrillators (ICDs). Patients with Ebste...
Published on May 1, 2019in Annals of Noninvasive Electrocardiology1.24
Andrés Ricardo Pérez-Riera10
Estimated H-index: 10
,
Raimundo Barbosa-Barros5
Estimated H-index: 5
+ 2 AuthorsKjell Nikus23
Estimated H-index: 23
(UTA: University of Tampere)
Published on Apr 2, 2019in Circulation23.05
Karen Stout2
Estimated H-index: 2
(American Association for Thoracic Surgery),
Karen K. Stout1
Estimated H-index: 1
(American Association for Thoracic Surgery)
+ 12 AuthorsJack M. Colman (American Association for Thoracic Surgery)
Glenn N. Levine, MD, FACC, FAHA, Chair Patrick T. O’Gara, MD, MACC, FAHA, Chair-Elect Jonathan L. Halperin, MD, FACC, FAHA, Immediate Past Chair Nancy M. Albert, PhD, RN, FAHA[§§][1] Sana M. Al-Khatib, MD, MHS, FACC, FAHA Joshua A. Beckman, MD, MS, FAHA Kim K. Birtcher, PharmD, MS,
Published on Apr 1, 2019in Heartrhythm Case Reports
Vlad Radulescu (Hofstra University), Joseph Donnelly (Hofstra University)+ 3 AuthorsShahryar G. Saba1
Estimated H-index: 1
(Hofstra University)
Published on Jan 1, 2019
Ian Lindsay2
Estimated H-index: 2
(Ronald Reagan UCLA Medical Center),
Ian Lindsay (Ronald Reagan UCLA Medical Center)+ 0 AuthorsSeshadri Balaji19
Estimated H-index: 19
(OHSU: Oregon Health & Science University)
Dysrhythmias represent one of the major causes of morbidity and mortality in ACHD patients, second only to heart failure, in both the acute and chronic settings. Several factors predispose this patient group to dysrhythmias, including congenital variations in the native conduction system, electromechanical effects of multiple surgical procedures, and altered hemodynamics. ACHD patients suffer from a wide array of rhythm disturbances, both supraventricular and ventricular, as well as tachy and br...
Published on Nov 1, 2018in Europace6.10
Antonio Hernández-Madrid15
Estimated H-index: 15
,
Thomas Paul23
Estimated H-index: 23
(GAU: University of Göttingen)
+ 36 AuthorsG.P. Diller1
Estimated H-index: 1
The population of patients with congenital heart disease (CHD) is continuously increasing with more and more patients reaching adulthood. A significant portion of these young adults will suffer from arrhythmias due to the underlying congenital heart defect itself or as a sequela of interventional or surgical treatment. The medical community will encounter an increasing challenge as even most of the individuals with complex congenital heart defects nowadays become young adults. Within the past 20...
Published on Oct 1, 2018in JACC: Clinical Electrophysiology
Edward P. Walsh65
Estimated H-index: 65
(Harvard University)
Abstract Ebstein’s anomaly of the tricuspid valve is a relatively rare form of congenital heart disease that has long been a challenge to electrophysiologists and cardiac surgeons. In addition to the hemodynamic burden of the actual valve defect, Ebstein’s patients must also contend with an extraordinarily high incidence of tachyarrhythmias, most of which can be attributed to accessory atrioventricular pathways (APs) located along the posterior and septal border of the tricuspid valve where the ...
View next paperPACES/HRS Expert Consensus Statement on the Recognition and Management of Arrhythmias in Adult Congenital Heart Disease