title: Retrograde multiple and multifiber accessory pathway conduction in the Wolff-Parkinson-White syndrome: potential precipitating factor of atrial fibrillation.
abstract: BACKGROUND
  The determinants of susceptibility to atrial fibrillation (AF) and the existence of accessory pathway conduction have remained unidentified in the Wolff-Parkinson-White (WPW) syndrome. We tested the hypothesis that excitation inputs into the atrium over a retrograde multiple or multifiber accessory pathway during AV reentrant tachycardia (AVRT) could precipitate initiation of AF.
  
  
  RESULTS
  Two hundred fifty consecutive patients with WPW syndrome underwent electrophysiologic study and radiofrequency catheter ablation. The patients were classified into two groups according to the study results: 29 with retrograde multiple or multifiber accessory pathway (MP) and 221 with retrograde single accessory pathway (SP). Compared with the SP patients, the MP patients showed a significantly higher incidence of clinical AF (MP vs SP: 19/29 vs 51/221, P < 0.01), induced AF (12/29 vs 32/221, P < 0.01), and initiated AF during ventricular pacing and AVRT (10/12 vs 17/32, P < 0.05). There were no differences between the two groups in incidence of clinical and induced AVRT (24/29 vs 200/221 and 25/29 vs 206/221, respectively), mean cycle length of induced AVRT, or electrophysiologic parameters of the accessory pathway. AF inducibility during AVRT or ventricular pacing was eliminated by partial ablation in 7 of 10 patients with MP. After total ablation, the incidence of induced AF was similar between the two groups (MP vs SP: 1/29 vs 11/221).
  
  
  CONCLUSIONS
  The existence of a retrograde multiple or multifiber accessory pathway in patients with WPW syndrome is associated with a higher incidence of clinical and induced AF. Successful ablation of the retrograde multiple or multifiber accessory pathway can eliminate the induction of both AVRT and AF.
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tokyo Medical and Dental University, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Iesaka
authors.forename: T
authors.initials: T
authors.lastname: Yamane
authors.forename: A
authors.initials: A
authors.lastname: Takahashi
authors.forename: M
authors.initials: M
authors.lastname: Goya
authors.forename: S
authors.initials: S
authors.lastname: Kojima
authors.forename: Y
authors.initials: Y
authors.lastname: Soejima
authors.forename: Y
authors.initials: Y
authors.lastname: Okamoto
authors.forename: H
authors.initials: H
authors.lastname: Fujiwara
authors.forename: K
authors.initials: K
authors.lastname: Aonuma
authors.forename: A
authors.initials: A
authors.lastname: Nogami
authors.forename: M
authors.initials: M
authors.lastname: Hiroe
authors.forename: F
authors.initials: F
authors.lastname: Marumo
authors.forename: M
authors.initials: M
authors.lastname: Hiraoka
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation; D004562:Electrocardiography; D004594:Electrophysiology; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009434:Neural Pathways / Q000503:physiopathology; D014927:Wolff-Parkinson-White Syndrome / Q000503:physiopathology* / Q000628:therapy