Prediction of a Fatal Atrial Fibrillation in Patients with Asymptomatic Wolff-Parkinson-White Pattern : 53th Annual Scientific Session of the Japanese Circulation Society

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• Paroxysmal atrial fibrillation (PAF) in patients with manifest WPW syndrome can be a life-threatening arrhythmia by deterioration into ventricular fibrillation. In patients with asymptomatic WPW pattern. the first PAF may lead to ventricular fibrillation or sudden death. Therefore, the purpose of this study was to predict a fatal PAF in patients with asymptomatic WPW pattern. The patient population was divided into two groups: (1) 145 patients with manifest WPW syndrome. excluding intermittent ones (32 with an episode of PAF. 49 with AV reciprocating tachycardia alone, and 64 without any episode of paroxysmal tachyarrhythmia), and (2) mixed group of patients with and without WPW syndrome (36 with an episode of PAF and 66 without PAF). The results were as follows: (1) (a) out of 32 patients with WPW syndrome and PAF, 8 patients were observed to have both the shortest preexcited R-R interval of less than 200 msec during PAF and the shortest antegrade effective refractory period of the accessory pathway (ERP-AP) of less than 250 msec, 7 of whom had dizziness or syncope during PAF and 2 died suddenly during the follow-up period; (b) 21 (32.8%) out of 64 patients with asymptomatic WPW pattern showed the shortest antegrade ERP-AP <250 msec; (2) patients with PAF had a higher tendency to develop repetitive atrial firing (RAF), as well as fragmented atrial activity (FAA), which were induced using programmed atrial stimulation. If a positive test result was defined as the induction of RAF and FAA, the positive predictive value was 63% and negative predictive value 79%. In conclusion, (1) having both the shortest R-R interval of less than 200 msec during PAF and the shortest antegrade ERP-AP of less than 250 msec might be a criterion for the identification of high risk in patients with WPW syndrome and PAF. (2) electrophysiologically revealed latent risk was observed in about one third of the patients with asymptomatic WPW pattern. in whom the ERP-AP was very short. (3) in these asymptomatic patients with combined RAF and FAA. the positive test result of atrial vulnerability might be of use to predict a fatal atrial fibrillation.

• 社団法人日本循環器学会の論文
• 1990-10-20

著者

• Fukatani Masahiko

  The Third Department Of Internal Medicine Nagasaki University School Of Medicine

• Fukatani Masahiko

  長崎大学 第3内科

• Shimizu Akihiko

  Faculty Of Health Science Yamaguchi University School Of Medicine

• Tanigawa Muneo

  Nagasaki Kita Hospital

• Hashiba Kunitake

  The Third Department of Internal Medicine, Nagasaki University School of Medicine

• Shimizu Akihiko

  The Third Department Of Internal Medicine Nagasaki University School Of Medicine

• FUKUTANI MASAHIKO

  The Third Department of Internal Medicine, Nagasaki University School of Medicine

• TANIGAWA MUNEO

  The Third Department of Internal Medicine, Nagasaki University School of Medicine

• MORI MITSUHIRO

  The Third Department of Internal Medicine, Nagasaki University School of Medicine

• KONOE ATSUSHI

  The Third Department of Internal Medicine, Nagasaki University School of Medicine

• KADENA MITSUO

  The Third Department of Internal Medicine, Nagasaki University School of Medicine

• Kadena Mitsuo

  Third Department Of Internal Medicine Nagasaki University School Of Medicine

• Konoe Atsushi

  The Third Department Of Internal Medicine Nagasaki University School Of Medicine

• Mori Mitsuhiro

  The Third Department Of Internal Medicine Nagasaki University School Of Medicine

• Hashiba Kunitake

  Third Department Of Internal Medicine Nagasaki University School Of Medicine

• Hashiba Kunitake

  The Third Department Of Internal Medicine

• Tanigawa Muneo

  Third Department Of Internal Medicine Nagasaki University School Of Medicine

• Fukatani Masahiko

  Third Department Of Internal Medicine Nagasaki University School Of Medicine

• Konoe Atsushi

  Third Department Of Internal Medicine Nagasaki University School Of Medicine

• Hashiba Knitake

  The Third Department Of Internal Medicine Nagasaki University School Of Medicine

• Tanigawa Muneo

  The Third Department Of Internal Medicine Nagasaki University School Of Medicine

• Hashiba Kunitake

  The Third Dept. Of Intern. Med. Nagasaki Univ. School Of Med.

• Hashiba Kunitake

  The 3rd Department Of Internal Medicine Nagasaki University

• Fukatani M

  Third Department Of Internal Medicine Nagasaki University School Of Medicine

• Fukutani Masahiko

  3rd Dept. Of Intern. Med. Nagasaki Univ. School Of Med.

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