Skip to main content
PMC home page
British Heart Journal logoLink to British Heart Journal
. 1987 Aug;58(2):89–95. doi: 10.1136/hrt.58.2.89

Inducible multiform ventricular tachycardia in Wolff-Parkinson-White syndrome.

B Brembilla-Perrot, A Terrier de la Chaise, K Isaaz, F Marçon, F Cherrier, C Pernot
PMCID: PMC1277285  PMID: 3620260

Abstract

The induction of ventricular tachycardia by ventricular stimulation was investigated in 46 patients with isolated Wolff-Parkinson-White syndrome (10 concealed) and 36 control patients with normal electrocardiograms and conduction systems. None of those studied had spontaneous ventricular arrhythmias or myocardial or valve disease. Single and double ventricular extrastimuli were delivered at 3 cycle lengths (sinus, 600 ms, 400 ms). In the controls ventricular simulation induced one episode (3%) of non-sustained ventricular tachycardia. Ventricular stimulation in patients with Wolff-Parkinson-White syndrome induced two episodes of ventricular fibrillation and 15 episodes of non-sustained multiform ventricular tachycardia (37%). Ventricular arrhythmias were induced only in patients with overt Wolff-Parkinson-White syndrome. In 14 patients the conformation of the electrocardiogram at the start of ventricular tachycardia resembled that of major pre-excitation. The absence of inducible ventricular tachycardia in patients with concealed Wolff-Parkinson-White syndrome suggests that anterograde conduction via an atrioventricular accessory pathway is required to initiate the ventricular arrhythmias: the ventricular tachycardia may be associated with reentry of impulses via atrioventricular connection during the phase of ventricular vulnerability. The similarity between the start of ventricular tachycardia and pre-excitatory complexes may also indicate local reentry into the ventricular area occupied by the bypass tracts. Patients with Wolff-Parkinson-White syndrome and anterograde pre-excitation are more likely to have inducible multiform ventricular tachycardia than individuals without Wolff-Parkinson-White syndrome.

Full text

PDF
89

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Benditt D. G., Pritchett E. L., Gallagher J. J. Spectrum of regular tachycardias with wide QRS complexes in patients with accessory atrioventricular pathways. Am J Cardiol. 1978 Nov;42(5):828–838. doi: 10.1016/0002-9149(78)90104-2. [DOI] [PubMed] [Google Scholar]
  2. Brembilla-Perrot B., Aliot E., Louis P., Terrier de la Chaise A., Khalife K., Marçon F., Cherrier F., Gilgenkrantz J. M., Pernot C. Devenir de 195 patients atteints de syndrome de Wolff-Parkinson-White. Arch Mal Coeur Vaiss. 1987 Mar;80(3):271–277. [PubMed] [Google Scholar]
  3. Brugada P., Green M., Abdollah H., Wellens H. J. Significance of ventricular arrhythmias initiated by programmed ventricular stimulation: the importance of the type of ventricular arrhythmia induced and the number of premature stimuli required. Circulation. 1984 Jan;69(1):87–92. doi: 10.1161/01.cir.69.1.87. [DOI] [PubMed] [Google Scholar]
  4. Campbell R. W., Smith R. A., Gallagher J. J., Pritchett E. L., Wallace A. G. Atrial fibrillation in the preexcitation syndrome. Am J Cardiol. 1977 Oct;40(4):514–520. doi: 10.1016/0002-9149(77)90065-0. [DOI] [PubMed] [Google Scholar]
  5. Deal B. J., Keane J. F., Gillette P. C., Garson A., Jr Wolff-Parkinson-White syndrome and supraventricular tachycardia during infancy: management and follow-up. J Am Coll Cardiol. 1985 Jan;5(1):130–135. doi: 10.1016/s0735-1097(85)80095-4. [DOI] [PubMed] [Google Scholar]
  6. Giardina A. C., Ehlers K. H., Engle M. A. Wolff-Parkinson-White syndrome in infants and children. A long-term follow-up study. Br Heart J. 1972 Aug;34(8):839–846. doi: 10.1136/hrt.34.8.839. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Gressard A., Atallah G., Chatelain M. T., Touboul P. Genèse de la fibrillation auriculaires dans le syndrome de Wolff-Parkinson-White. Arch Mal Coeur Vaiss. 1981 Nov;74(11):1277–1282. [PubMed] [Google Scholar]
  8. Krikler D. M., Davies M. J., Rowland E., Goodwin J. F., Evans R. C., Shaw D. B. Sudden death in hypertrophic cardiomyopathy: associated accessory atrioventricular pathways. Br Heart J. 1980 Mar;43(3):245–251. doi: 10.1136/hrt.43.3.245. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Leclercq J. F., Cauchemez B., Attuel P., Childers R., Coumel P., Slama R. Rythme réciproque antidromique sur Wolff-Parkinson-White déclenché par une extrasystolie ventriculaire provenant du lieu d'émergence de la voie de préexcitation. Arch Mal Coeur Vaiss. 1983 Jan;76(1):95–103. [PubMed] [Google Scholar]
  10. Livelli F. D., Jr, Bigger J. T., Jr, Reiffel J. A., Gang E. S., Patton J. N., Noethling P. M., Rolnitzky L. M., Gliklich J. I. Response to programmed ventricular stimulation: sensitivity, specificity and relation to heart disease. Am J Cardiol. 1982 Sep;50(3):452–458. doi: 10.1016/0002-9149(82)90309-5. [DOI] [PubMed] [Google Scholar]
  11. Lloyd E. A., Hauer R. N., Zipes D. P., Heger J. J., Prystowsky E. N. Syncope and ventricular tachycardia in patients with ventricular preexcitation. Am J Cardiol. 1983 Jul;52(1):79–82. doi: 10.1016/0002-9149(83)90073-5. [DOI] [PubMed] [Google Scholar]
  12. Milstein S., Sharma A. D., Klein G. J. Nonclinical ventricular tachycardia in the Wolff-Parkinson-White syndrome. Pacing Clin Electrophysiol. 1985 Sep;8(5):678–683. doi: 10.1111/j.1540-8159.1985.tb05880.x. [DOI] [PubMed] [Google Scholar]
  13. Morady F., Shapiro W., Shen E., Sung R. J., Scheinman M. M. Programmed ventricular stimulation in patients without spontaneous ventricular tachycardia. Am Heart J. 1984 May;107(5 Pt 1):875–882. doi: 10.1016/0002-8703(84)90821-4. [DOI] [PubMed] [Google Scholar]
  14. Reddy C. P., Sartini J. C., Kuo C. S. Paroxysmal ventricular tachycardia in Wolff-Parkinson-White syndrome: case report and review of the literature. J Electrocardiol. 1982 Oct;15(4):403–410. doi: 10.1016/s0022-0736(82)81016-9. [DOI] [PubMed] [Google Scholar]
  15. Rossi L. A histological survey of pre-excitation syndrome and related arrhythmias. G Ital Cardiol. 1975;5(6):816–828. [PubMed] [Google Scholar]
  16. Sharma A. D., Klein G. J., Guiraudon G. M., Milstein S. Atrial fibrillation in patients with Wolff-Parkinson-White syndrome: incidence after surgical ablation of the accessory pathway. Circulation. 1985 Jul;72(1):161–169. doi: 10.1161/01.cir.72.1.161. [DOI] [PubMed] [Google Scholar]
  17. Sung R. J., Castellanos A., Mallon S. M., Bloom M. G., Gelband H., Myerburg R. J. Mechanisms of spontaneous alternation between reciprocating tachycardia and atrial flutter-fibrillation in the Wolff-Parkinson-White syndrome. Circulation. 1977 Sep;56(3):409–416. doi: 10.1161/01.cir.56.3.409. [DOI] [PubMed] [Google Scholar]
  18. Vandepol C. J., Farshidi A., Spielman S. R., Greenspan A. M., Horowitz L. N., Josephson M. E. Incidence and clinical significance of induced ventricular tachycardia. Am J Cardiol. 1980 Apr;45(4):725–731. doi: 10.1016/0002-9149(80)90114-9. [DOI] [PubMed] [Google Scholar]
  19. Warnowicz M. A., Santucci B. A., Bucheleres H. G., Denes P. Myocardial dysfunction during paroxysmal supraventricular tachycardia. Circulation. 1981 Aug;64(2):421–426. doi: 10.1161/01.cir.64.2.421. [DOI] [PubMed] [Google Scholar]
  20. Wellens H. J., Brugada P., Stevenson W. G. Programmed electrical stimulation of the heart in patients with life-threatening ventricular arrhythmias: what is the significance of induced arrhythmias and what is the correct stimulation protocol? Circulation. 1985 Jul;72(1):1–7. doi: 10.1161/01.cir.72.1.1. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES