title: A case series of patients with poorly-tolerated arrhythmias related to a preexcitation syndrome and presenting with atypical ECG.
abstract: The aim of study was to report different and unusual patterns of preexcitation syndrome (PS) noted in patients referred for studied for poorly-tolerated arrhythmias and their frequency. Electrophysiologic study (EPS) is an easy means to identify a patient with PS at risk of serious events. However the main basis for this diagnosis is the ECG which associates short PR interval and widening of QRS complex with a delta wave.
  
  
  METHODS
  ECGs of 861 patients in whom PS related to an atrioventricular accessory pathway (AP) was identified at electrophysiological study (EPS), were studied.
  
  
  RESULTS
  The most frequent unusual presentation (9.6%) was the PS presenting with a normal or near normal ECG, noted preferentially for left lateral AP and rarely for posteroseptal or right lateral location. More exceptional (0.1%) was the presence of a long PR interval, which did not exclude a rapid conduction over AP. The association of a complete AV block with symptomatic tachycardias was exceptional (0.3%) and was shown related to a rapid conduction over AP after isoproterenol. Most of the presented patients were at high-risk at EPS.
  
  
  CONCLUSIONS
  The diagnosis of PS is not always evident and symptoms should draw attention to minor abnormalities and lead to enlarge indications of EPS, only means to confirm or not PS.
authors.affiliation: Department of Cardiology, University Hospital of Brabois, Vandoeuvre Les Nancy, France. Electronic address: b.brembilla-perrot@chu-nancy.fr.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Brembilla-Perrot
authors.affiliation: Department of Cardiology, University Hospital of Brabois, Vandoeuvre Les Nancy, France.
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Sellal
authors.affiliation: Department of Cardiology, University Hospital of Brabois, Vandoeuvre Les Nancy, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Olivier
authors.affiliation: Department of Cardiology, University Hospital of Brabois, Vandoeuvre Les Nancy, France.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Manenti
authors.affiliation: Department of Cardiology, University Hospital of Brabois, Vandoeuvre Les Nancy, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Beurrier
authors.affiliation: Department of Cardiology, University Hospital of Brabois, Vandoeuvre Les Nancy, France.
authors.forename: Bassam
authors.initials: B
authors.lastname: Al Jouma
authors.affiliation: Department of Cardiology, University Hospital of Brabois, Vandoeuvre Les Nancy, France.
authors.forename: Marius
authors.initials: M
authors.lastname: Andronache
authors.affiliation: Department of Cardiology, University Hospital of Brabois, Vandoeuvre Les Nancy, France.
authors.forename: Christian
authors.initials: C
authors.lastname: de Chillou
authors.affiliation: Department of Cardiology, University Hospital of Brabois, Vandoeuvre Les Nancy, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Girerd
authors.affiliation: Department of Cardiology, University Hospital of Brabois, Vandoeuvre Les Nancy, France.
authors.forename: Thibaut
authors.initials: T
authors.lastname: Villemin
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000209:etiology; D004562:Electrocardiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D011226:Pre-Excitation Syndromes / Q000150:complications* / Q000503:physiopathology*; D012189:Retrospective Studies
keywords: ECG; Electrophysiologic study; Wolff–Parkinson–White syndrome