Original Articles Wolff-Parkinson-White 증후군의임상상및 전기생리학적소견 * Abstract 안신기 1 이문형 1 장양수 1 오동진 2 최인석 3 하종원 1 임세중 1 김병옥 4 정남식 1 심원흠 1 조승연 1 김성순 1

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1 Original Articles Wolff-Parkinson-White 증후군의임상상및 전기생리학적소견 * Abstract 안신기 1 이문형 1 장양수 1 오동진 2 최인석 3 하종원 1 임세중 1 김병옥 4 정남식 1 심원흠 1 조승연 1 김성순 1 Clinical and Electrophysiologic Characteristics of the Patients with Wolff-Parkinson-White Syndrome Shin-Ki Ahn, M.D., 1 Moon-Hyoung Lee, M.D., 1 Yang-Soo Jang, M.D., 1 Dong-Jin Oh, M.D., 2 In Suck Choi, M.D., 3 Jong Won Ha, M.D., 1 Se Joong Rim, M.D., 1 Byung-Ok Kim, M.D., 4 Nam-Sik Chung, M.D., 1 Won Heum Shim, M.D., 1 Seung Yun Cho, M.D., 1 Sung Soon Kim, M.D. 1 Cardiology Division, Yonsei Cardiovascular Center, 1 Yonsei University, Seoul, Korea Department of Internal Medicine, 2 Kang Dong Sacred Heart Hospital, Hallym University, Seoul, Korea Department of Internal Medicine, 3 Jung-ang Gil Hospital, Inchon, Korea Sanggye Paik Hospital, Department of Internal Medicine, 4 College of Medicine, Inje University, Seoul, Korea BackgroundWolff-Parkinson-White syndromewpw syndrome is well known and sometimes causes life-threatening arrhythmias. To date, the clinical and electrophysiologic characteristics of patients with WPW syndrome in Korea has not been available, though results of catheter ablation treatment for atrioventricular reentrant tachycardiaavrt including WPW syndrome were reported. MethodClinical and electrocardiographicecg characteristics and results of electrophysiologic study of consecutive 400 patients with WPW syndrome who underwent electrophysiologic study between December 1986 and September 1995 were analyzed. ResultsMean age of the patients was 35 years and male patients were more common262 male patients, 65.5%. Mean duration and frequency of palpitation episodes were 8.1 years and 4.2 times per month, respectively. Thirty six patients9.0% experienced syncopal episodes and the half of them were associated with atrial fibrillation. Two cases of aborted sudden cardiac death were associated with atrial fibrillation. Twenty four cases of congenital heart diseases and 13 cases of acquired heart diseases were found. The most commonly associated cardiac disease was Ebstein s anomaly8 cases, 2.0%. Clinically, 368 patients92.0% had ECG-documented tachycardias and

2 patients had two or more types of tachycardia. Orthodromic AVRT was the most common tachycardia 277 patients including 44 cases with coexisting atrial fibrillation. Atrial fibrillation was documented in 115 patients31.3% and antidromic AVRT in 23 patients6.2%. Patients with antidromic AVRT were more likely to have multiple accessory pathways compared to those with orthodromic AVRT 30.4% versus 4.3%. On electrophysiologic study, the most commonly inducible tachycardia was also orthodromic AVRT 344/389 cases, 89.8%. Antidromic AVRT was induced in 23 cases6.0%. Atrial fibrillation was present in 104 patients27.2%, especially in those with clinically documented atrial fibrillation71.3% vs 12.3%. In 17 patients without inducible tachycardias, ventriculoatrial conduction was absent or had long effective refractory period. Finally, 396 patients99.0% had clinically documented or inducible tachycardias. Eight patients with Ebsteins anomaly had right-sided accessory pathway87.5% except one case. Twenty four patients had secondary accessory pathway. The most common site of accessory pathway including secondary accessory pathway was left free wall204 cases, 48.1%. Other accessory pathways were found at right free wall123 cases, 29.0%, posteroseptal54 cases, 17.5% and anteroseptal site15 cases, 3.5% in order. ConclusionsThe clinical and electrophysiologic characteristics of patients in this series were similar with those of previous reports of other countries. Because certain types of tachyarrhythmia were associated with characteristic electrophysiologic findings such as the relationships between antidromic AVRT and presence of secondary accessory pathways or clinical atrial fibrillation and higher occurrence rate of atrial fibrillation during electrophysiologic study, it is important to document clinical tachyarrhythmias with ECG. And electrophysiologic study can have important clinical implications in diagnosis and especially in curative treatment. KEY WORDSWolff-Parkinson-White syndrome Clinical and electrophysiologic characteristics. 서론 대상및방법 1. 대상 2. 방법 849

3 결과 1. WPW 증후군환자의임상상 Fig. 1. Classification and distribution of 424 accessory pathways in 400 patients with WPW syndrome. AVNAV node, ASanteroseptal, MSmidseptal, LAleft anterior, LLleft lateral, LPleft posterior, LpLleft posterolateral, PSposteroseptal, RA:right anterior, RLright lateral, RPright posterior, RpL:right posterolateral 850

4 Table 1. Clinical profiles of 400 patients with WPW syndrome in Yonsei Cardiovascular Center Dec Sep Sex Male 262 Female 138 Age MeanS.D years Range 375 years Symptoms Duration years Frequency times/month Duration of each episode hours/episode Syncope% 369.0% Table 2. Associated cardiac anomalies in 400 patients with WPW syndrome Congenital 24 Ebstein s anomaly 8 ASD 5 Corrected TGV 2 Persistent left SVC 2 Dextrocardia 2 Hypoplastic CS 2 VSD 1 DORV 1 Rhabdomyoma 1 Acquired 13 Cardiomyopathy 5 Hypertrophic 3 Dilated 1 Tachycardia-mediated 1 MS, MR 4 AR, AS 3 TR 1 ARaortic regurgitation, ASaortic stenosis, ASD atrial septal defect, CScoronary sinus, DORVdouble outlet right ventricle, MSmitral stenosis, MRmitral regurgitation, TGVtransposition of great vessels, TR tricuspid regurgitation, SVC superior vena cava, VSDventricular septal defect 2. 임상적으로발현된부정맥 3. 전기생리학검사결과 1) 유도된부정맥 Table 3. Types of tachyarrhythmias in 368 patients with ECG documentation Types of tachycardias No% Orthodromic AVRT 277/ AVRT only 233 With Afib 43 With antidromic AVRT, Afib 1* Antidromic 23/ Only 20 With Afib 2 With Afib, orthodromic AVRT 1* Afib 115/ Only 69 Afibatrial fibrillation, AVRTatrioventricular reentrant tachycardia *a patient with orthodromic and antidromic AVRT and atrial fibrillation including patients with AVRT 851

5 Fig. 2. Clinically documented tachyarrhythmias in 400 patients with WPW syndrome. Afibatrial fibrillation, AVRTatrioventricular reentrant tachycardia *Proportion among 368 documented tachyarrhythmias Table 4. Induced and clinically documented tachyarrhythmias in 400 patients with WPW syndrome Clinically documented arrhythmia Induced AVRT AVRT with afib arrhythmia Afib Not Ortho Anti Ortho Anti Both only documented AVRT Ortho Anti Both Afib Only Ortho Anti Both Not inducible Total Afibatrial fibrillation, Antiantidromic, AVRTatrioventricular reentrant tachycardia, Orthoorthodromic Total 852

Fig. 3. Induced tachyarrhythmias during electrophysiologic study. Orthodromic AVRT was most commonly documented and induced tachyarrhythmia.

6 Fig. 3. Induced tachyarrhythmias during electrophysiologic study. Orthodromic AVRT was most commonly documented and induced tachyarrhythmia. Atrial fibrillation was more likely to be induced in patients with clinically documented atrial fibrillation. AVRTOorthodromic AVRT, AVRTAantidr-omic AVRT, cwith, c/swith or without, Afibatrial fibrillation Table 5. Location of accessory pathways of 400 patients with WPW syndrome Site of accessory Primary Secondary Total% pathway Left free wall Lateral Posterior and posterolateral Anterior and anterolateral Right free wall Lateral and posterolateral Posterior Anterior Posteroseptal Right-sided Left-sided Anteroseptal Midseptal Para-Hisian Total ) 우회로의분포 Fig. 4. AVRT type and multiple accessory pathways. Patients with multiple accessory pathways were more likely to have antidromic AVRTA. Antidromic AVRT was significantly associated with presence of multiple accessory pathwaysb. *Fisher s exact test p

7 고안 854

8 855

9 856

10 요약 연구배경 : 방법 : 결과 : 결론 : 857

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Original Articles 심실조기흥분증후군에서역방향방실회귀성빈맥의 Abstract 임상적및전기생리학적특성 * 최동훈 이문형 안신기 김성순 Electrophysiologic and Clinical Characteristics of Antidrom

Original Articles 심실조기흥분증후군에서역방향방실회귀성빈맥의 Abstract 임상적및전기생리학적특성 * 최동훈 이문형 안신기 김성순 Electrophysiologic and Clinical Characteristics of Antidrom Original Articles 27 4 1997 심실조기흥분증후군에서역방향방실회귀성빈맥의 Abstract 임상적및전기생리학적특성 * 최동훈 이문형 안신기 김성순 Electrophysiologic and Clinical Characteristics of Antidromic Reentrant Tachycardia in Ventricular Preexcitation