Structural heart diseases associated with WPW syndrome

Structural heart diseases associated with WPW syndrome

Ebstein’s anomaly, hypertrophic cardiomyopathy and mitral valve prolapse  are the important structural heart diseases associated with Wolff-Parkinson-White Syndrome. 

Developmental anomaly of the tricuspid valve is associated with delayed intraatrial conduction, right bundle branch block and accessory atrioventricular pathways in Ebstein’s anomaly [1]. In a series of 224 patients, 28% had documented tachycardia. Thirty three with recurrent tachycardia had a single right sided accessory pathway which was successfully ablated. Only 21 of the 33 patients had typical ECG pattern of preexcitation.

An interesting finding was that none had an ECG pattern of right bundle branch block during sinus rhythm. Radiofrequency catheter ablation resulted in the appearance of RBBB in 94% of patients. Absence of RBBB in patients with Ebstein’s anomaly with recurrent tachycardia had 98% sensitivity and 92% specificity for the diagnosis of an accessory pathway [1].

An interesting case of hypertrophic obstructive cardiomyopathy, sinus tachycardia and pulmonary edema has been reported. Coronary angiogram was normal and she was discharged on metoprolol after recovery. One month later she presented with atrioventricular tachycardia and underwent accessory pathway ablation. Still another two weeks later she presented with ventricular tachycardia and was given an implantable cardioverter defibrillator. She had all typical complications of hypertrophic obstructive cardiomyopathy which were promptly and successfully treated [2].

References

1. Pedro Iturralde Torres. Wolff-Parkinson-White Syndrome in Ebstein’s Anomaly. Arch Cardiol Mex. Apr-Jun 2007;77 Suppl 2:S2-37-S2-39.
2. Mehmet Bulent Vatan, Huseyin Gunduz, Safiye Gurel, Ibrahim Kocayigit, Ahmet Vural, Saadet Demirtas, Mehmet Akif Cakar, Yasemin Gunduz. An Unusual Type of Localized Hypertrophic Cardiomyopathy With Wolf Parkinson White Syndrome Presenting With Pulmonary Edema. Cardiol Res. 2012 Jun;3(3):133-136.