[Wolff-Parkinson-White syndrome with orthodromic supraventricular tachycardia associated with a "hyper-conductor" atrio-ventricular node. A therapeutic challenge].
One case of Wolff-Parkinson-White Syndrome with paroxysmal supraventricular tachycardia related to orthodromic atrioventricular reentry using an accessory pathway for retrograde conduction an a rapidly conducting AV node for anterograde conduction is present. The pharmacological therapy with Digoxin, Propranolol, Quinidine, Disopyramide and Propafenone was not effective. An electrophysiologic study showed a reciprocating tachycardia induced by spontaneous ventricular beats. Both the effective refractory period of the AV node and the anterograde effective refractory period of the accessory pathway were minor or equal to 220 msec which made the control of the arrhythmia difficult. Amiodarone was able to suppress the premature ventricular beats, depress conduction and prolong refractoriness in both, the AV node and accessory pathway to prevent recurrences of atrioventricular reentry. In this patient a false positive test with ajmaline was documented. The electrophysiologic study showed the association of Wolff-Parkinson-White Syndrome with an enhanced atrioventricular nodal-conduction and allowed the selection of an appropriate antiarrhythmic agent.
Hernández González
D
D
Departamento de Electrocardiografía y Electrofisiología del Instituto Nacional de Cardiología Ignacio Chávez, México, D.F.
Iturralde Torres
P
P
Romero
L
L
Colín
L
L
Villarreal
A
A
González Hermosillo
J A
JA
D000328:Adult; D001283:Atrioventricular Node; D004562:Electrocardiography; D004594:Electrophysiology; D005260:Female; D006801:Humans; D013614:Tachycardia, Paroxysmal / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology*; D013617:Tachycardia, Supraventricular / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D014927:Wolff-Parkinson-White Syndrome / Q000150:complications / Q000503:physiopathology*
Síndrome de Wolff-Parkinson-White con taquicardia supraventricular ortodrómica asociado a un nodo auriculo-ventricular "hiperconductor". Un reto terapéutico.