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Wolff-Parkinson-White syndrome and atrial fibrillation

Identifieur interne : 000050 ( Main/Corpus ); précédent : 000049; suivant : 000051

Wolff-Parkinson-White syndrome and atrial fibrillation

Auteurs : Hein J. Wellens ; Dirk Durrer

Source :

RBID : ISTEX:48205AD803E011E83FC0951C92ED63E8B29567CC

Abstract

To assess the relation between the length of the effective refractory period of the accessory pathway and the ventricular rate during atrial fibrillation, we studied two groups of patients with the Wolff-Parkinson-White syndrome: Group I, 17 patients with electrocardiographlcally documented episodes of atrial fibrillation, and Group II, 9 patients without this arrhythmia. In 17 of these 26 patients the effective refractory period of the accessory pathway could be determined by the single test stimulus method during atrial pacing.After measurement of the refractory period, atrial fibrillation was induced by rapid atrial pacing (400 to 500/min). The duration of the effective refractory period of the accessory pathway was found to correlate with the shortest R-R interval and the mean ventricular rate during documented or induced atrial fibrillation. In nine patients the effective refractory period of the accessory pathway could not be determined because the atrium became refractory while atrioventricular (A-V) conduction was still occurring over this pathway. In these patients the right atrium was regularly paced at rates of up to 280/min. All nine patients had 1:1 A-V conduction over the accessory pathway up to driving rates of 240/min. In five patients conduction still manifested a 1:1 ratio at pacing rates of 280/min. During atrial fibrillation all nine patients had a mean ventricular rate greater than 200/min.Although factors other than the effective refractory period of the accessory pathway affect ventricular rate during atrial fibrillation in patients with the Wolff-Parkinson-White syndrome, the duration of this period is of value in identifying patients at risk of having life-threatening high ventricular rates when atrial fibrillation occurs.

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DOI: 10.1016/0002-9149(74)90695-X

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ISTEX:48205AD803E011E83FC0951C92ED63E8B29567CC

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