0048: A long accessory pathway refractory period measured by oesophageal atrial stimulation is always associated with a benign form of preexcitation syndrome - 07/02/15
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Résumé |
Measurement of accessory pathway (AP) refractory period (RP) is required for the evaluation of preexcitation syndrome (PS). The purpose of study was to evaluate the measurement of AP-RP by transesophageal electrophysiological study (EPS) and intracardiac EPS.
Methods |
EPS was performed in 51 patients aged from 13 to 50 years (mean 30±16) for a PS. Atrial stimulation was performed in control state (CS) at a cycle length of 400ms and coupling was decereased until AP6RP or atrial RP. Measurement was repeated after isoproterenol when AP-RP≥250ms in CS. Measurement was performed by transesophageal route and then by intracardiac route, with a delay not >3 months.
Results |
AP-RP’s were 267±50ms in CS, 233±49ms after isoproterenol at transesophageal EPS, 309±72ms in CS, 280±64ms after isoproterenol at intracardiac EPS (p<0.002). Among 31 patients with initially AP-RP ≥250ms at transesophageal EPS, AP-RP was ≤220ms after isoproterenol in 12 patients. All, but one had an AP-RP≥250ms in CS at intracardiac EPS; one patient with AP-RP of 270ms at esophageal EPS had a value of 240ms at intracardiac EPS in CS but value was 250ms after isoproterenol. Three patients with transesophageal AP-RP in CS and after isoproterenol ≥280ms had lost their anterograde conduction. At transesophageal EPS, AP-RP was <250ms in 20 patients of which only 8 had a short AP-RP at intracardiac EPS and 3 had a short AP-RP after isoproterenol. There was no significant difference for the induction of orthodromic tachycardia at transesophageal and intracardiac EPS (72%) and there was a similar induction of atrial fibrillation at transesophageal EPS (32%) and intracardiac EPS (28%).
Conclusions |
A long AP refractory period measured at transesophageal EPS excluded the presence of an AP with a short refractory period at intracardiac study even after isoproterenol. There was an adrenergic factor during transesophageal EPS and isoproterenol produced a significant shortening of AP refractory periods in only 39% of patients with AP-RP ≥250ms. When AP-RP is ≥280ms at transesophageal EPS, the loss of anterograde conduction in AP can be expected in the following weeks (15%).
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Vol 7 - N° 1
P. 73-74 - janvier 2015 Retour au numéro
Article précédent
- 0040: Score for arrhythmias detection in symptomatic patients after AV node re-entrant tachycardia ablation
- Béatrice Brembilla-Perrot, Nicolas Girerd
- 0049: Long-term follow- up of AV conduction disturbances after slow pathway ablation in patients with AV node reentrant tachycardia
- Sarah Dorlet, Béatrice Brembilla-Perrot
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