[Wolff-Parkinson-White syndrome. Value of intravenous flecainide for detecting Kent's pathways with short refractory period].
The aim of this study was to assess the value of a non-invasive test in detecting accessory pathways with short anterograde effective refractory periods (AERP) (less than or equal to 270 ms) in patients with the Wolff-Parkinson-White syndrome. An intravenous injection of Flecainide acetate was administered to 19 consecutive patients referred for electrophysiological investigation of a WPW syndrome with permanent pre-excitation of the surface electrocardiogram. The first 8 patients (Group I) received a dose of 1.5 mg/kg over 5 minutes and the following 11 patients (Group II) were given 2 mg/kg in 5 minutes. In Group I, preexcitation disappeared in 3 patients (37.5%) who all had accessory pathways with AERP greater than 270 ms. It persisted in the other 5 patients (62.5%) of whom 4 had AERP less than or equal to 270 ms and 1 an AERP greater than 270 ms (false negative). In Group II, preexcitation disappeared in 8 patients (72.2%) of whom 4 had AERP greater than 270 ms and 4 had AERP less than 270 ms (false positives). Preexcitation persisted in the 3 other patients (27.3%); the AERP was less than or equal to 270 ms in 2 patients and greater than 270 ms in the other patients. These results suggest that intravenous Flecainide acetate at the dose of 1.5 mg/kg could be useful in differentiating WPW syndromes with long refractory periods (greater than 270 ms) from those with short refractory periods (less than or equal to 270 ms) with a satisfactory sensitivity and specificity, and that further studies on larger numbers of patients are required to confirm this hypothesis.
Talard
P
P
Clinique cardiologique, hôpital Cantini, Marseille.
Cointe
R
R
Bru
P
P
Moyal
C
C
Lacombe
P
P
Bremondy
M
M
Levy
S
S
Gerard
R
R
D000293:Adolescent; D000328:Adult; D002648:Child; D004562:Electrocardiography; D004594:Electrophysiology; D005260:Female; D005424:Flecainide / Q000008:administration & dosage; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D014927:Wolff-Parkinson-White Syndrome / Q000175:diagnosis* / Q000503:physiopathology
D005424:Flecainide
Syndrome de Wolff-Parkinson-White. Intérêt de la flécaïnide i.v. dans le dépistage des faisceaux de Kent à période réfractaire courte.