Supernormal Conduction in the Anomalous Bundles of the Wolff-Parkinson-White Syndrome: An Overlooked Electrophysiologic Property With Potential Clinical Implications
Free accessOtherFirst published online September, 2007
Supernormal Conduction in the Anomalous Bundles of the Wolff-Parkinson-White Syndrome: An Overlooked Electrophysiologic Property With Potential Clinical Implications
The anterograde refractory period (RP) of the accessory pathway (AP) is the main determinant factor of ventricular rate during atrial fibrillation in the Wolff-Parkinson-White (WPW) syndrome. We describe 3 examples of anterograde supernormal conduction (SNC) and 1 of retrograde SNC in APs. The paradoxical early recovery of propagation due to SNC, well inside a prolonged anterograde RP in the AP, may play a relevant role to determine the rate of ventricular response during atrial fibrillation, eventually leading to extremely fast ventricular rates, syncope, and even ventricular fibrillation in patients with WPW syndrome supposed a priori to be exposed to a low risk of sudden cardiac death. This may require very precise conditions, including an enhanced adrenergic influence on the heart. Retrograde SNC in APs may also participate in the mechanism of paroxysmal supraventricular tachycardias that are not easily induced by programmed cardiac stimulation.
Wellens Hjj, Durrer D.Relation between refractory period of the accessory pathway and ventricular frequency during atrial fibrillation in patients with the Wolff-ParkinsonWhite syndrome. Am J Cardiol.1974;34:777-782.
2.
Klein GJ, Bashore TM, Sellers TD, Pritchett EL, Smith WM, Gallagher JJVentricular fibrillation in the Wolff-Parkinson-White syndrome. N Engl J Med.1979;301: 1080-1085.
3.
Attoyan C., Haissaguerre M., Dartigues JF, Le Metayer P., Warin JF, Clementy J.La fibrillation ventriculaire dans le syndrome de Wolff-Parkinson-White. Facteurs prédictifs. Arch Mal Coeur Vaiss.1994;87:889-896.
4.
Wellens Hjj.El síndrome de Wolff-Parkinson-White en individuos asintomáticos. In: Elizari MV, Chiale PA, eds. Arritmias Cardíacas. Fundamentos Celulares y Moleculares, Diagnóstico y Tratamiento. Buenos Aires , Argentina: Editorial Médica Panamericana; 2003:511-515.
5.
Wellens Hjj.Wolff-Parkinson-White syndrome. Part I. Mod Concepts Cardiovasc Dis. 1983;52:53-78.
6.
Levy S., Bronstet JP, Clementy J.Syndrome de WolffParkinson-White. Correlation entre l'exploration electrophysiologíque et l'effet de l'epreuve d'effort sur l'aspect electrocardiographique de pre-excitation . Arch Mal Coeur Vaiss. 1979;72:634-642.
7.
Wellens Hjj, Bar FW, Gorgels, Vanagt EJUse of ajmaline in patients with the Wolff-Parkinson-White syndrome to disclose short refractory period of their accessory pathway. Am J Cardiol.1980;45:130-133.
8.
Wellens Hjj, Braat SH, Brugada P., Gorgels AP, Bar FWUse of procainamide in patients with the Wolff-Parkinson-White syndrome and a short refractory period of the accessory pathway. Am J Cardiol.1982;50:1087-1089.
9.
Przybylski J. , Chiale PA, Halpern MS, Nau GJ, Elizari MV, Rosenbaum MBUnmasking of ventricular preexcitation by vagal stimulation or isoproterenol administration. Circulation . 1980;61:1030-1037.
10.
Przybylski J., Chiale PA, Sánchez RA, et al. Supernormal conduction in the accessory pathway of patients with overt or concealed preexcitation. J Am Coll Cardiol.1987;9:1269-1278.
11.
Chang MS, Miles WM, Prystowsky ENSupernormal conduction in accessory atrioventricular connections. Am J Cardiol.1987;59:852-856.
12.
Levi RJ, Salerno JA, Nau GJ, Elizari MV, Rosenbaum MBA reappraisal of supernormal conduction. In: Rosenbaum MB, Elizari MV, eds. Frontiers of Cardiac Electrophysiology. The Hague, Netherlands: Martinus Nijhoff; 1983:427-456.
13.
Suguta M., Nogami A., Naito S., et al. Retrograde supernormal conduction in concealed accessory atrioventricular pathway following catheter ablation. J Cardiovasc Electrophysiol . 1997;8:1291-1295.
14.
Rosenbaum MB , Levi RJ, Elizari MV, Vetulli HM, Sánchez RASupernormal excitability and conduction. Cardiol Clin. 1983;1:75-92.
15.
McHenry PL, Knoebel S., Fisch C.The Wolff-ParkinsonWhite (WPW) syndrome with supernormal conduction through the anomalous bypass. Circulation. 1966;34: 734-739.
16.
Chen PS, Prystowsky E.Role of concealed and supernormal conductions during atrial fibrillation in the preexcitation syndrome. Am J Cardiol.1991;68:1329-1334.
17.
Chiale PA, Contreras L.El síndrome de Wolff-Parkinson-White y las taquiarritmias asociadas. In: Elizari MV, Chiale PA, eds. Arritmias Cardíacas. Fundamentos Celulares y Moleculares, Diagnóstico y Tratamiento. Buenos Aires , Argentina: Editorial Médica Panamericana; 2003:471-495.
18.
Aldariz AE, Levi RJ, Acunzo RS, Halpern MSConducción 1:1 en fase supernormal. Rev Arg Cardiol. 1998;66:203-211.
19.
Basso C., Corrado D., Rossi L., Thiene G.Ventricular preexcitacion in children and young adults: atrial myocarditis as a possible trigger of sudden death. Circulation. 2001; 103:269-275.
20.
Furlanello F., Vecchiet L., Bettini R., et al. Arritmias en Atletas. In: Cosin J, Bayés de Luna A, García Civera R, Cabades A, eds. Diagnóstico y Tratamiento de las Arritmias Cardíacas . Barcelona, Spain: Doyma; 1988:230-234.
21.
Spear JF, Moore ENSupernormal excitability and conduction in the His-Purkinje system of the dog. Circ Res.1974;35:782-792.
