Comparison of clinical and electrophysiologic features of preexcitation syndromes in patients presenting initially after age 50 years with those presenting at younger ages

doi:10.1016/0002-9149(91)90526-Q

The American Journal of Cardiology

Volume 67, Issue 8, 1 April 1991, Pages 709-712

https://doi.org/10.1016/0002-9149(91)90526-Q Get rights and content

Abstract

Although patients may develop arrhythmias due to preexcitation syndromes at any time from the prenatal period to late adulthood, presentation in late adulthood is considered uncommon and has not been well studied. From June 1981 to June 1989, 73 patients were documented to have preexcitation syndromes on the basis of electrophysiologic studies. Those whose initial arrhythmias appeared at an age >50 years (group 1, n = 13) were compared with the remaining 60 patients (group 2).

All group 1 patients presented in the setting of acute medical or surgical diseases (n = 7), or chronic cardiac disease (n = 6) commonly associated with middle age and often with atrial arrhythmias; only 13 group 2 patients had underlying illnesses (p = 0.0001). Almost two-thirds of group 2 patients were evaluated because of narrow complex orthodromic tachycardia or palpitations and electrocardiographic evidence of preexcitation. Wide complex tachycardia was more often a reason for referral of older patients (7 of 13 vs 11 of 60, p < 0.05), among whom atrial fibrillation/flutter also tended to be more frequent (4 of 13 vs 11 of 60, difference not significant). The PR and QRS intervals of group 1 patients were within the normal range and differed significantly from those of group 2 patients (PR, 0.15 ± 0.04 vs 0.11 ± 0.03 second, p < 0.001; QRS, 0.09 ± 0.01 vs 0.12 ± 0.03 second, p < 0.001), making electrocardiographic identification of preexcitation more difficult in group 1. Several factors likely contributed. Concealed bypass tracts tended to appear more frequently in older patients (5 of 13 vs 8 of 60, p = 0.047), but intraatrial conduction delays as measured by the P-wave duration (103 ± 21 vs 90 ± 16 ms, p = 0.023), and the time from the onset of the P wave to the low right atrial electrogram (48 ± 19 vs 38 ± 15 ms, p = 0.042) may have contributed.

Thus, as in infancy, specific age-related descriptors characterize patients presenting with preexcitation syndromes over the age of 50 years. Awareness of these descriptors will facilitate care of these adults.

References (15)

L Wolff et al.
Bundle-branch block with short P-R interval in healthy young people prone to paroxysmal tachycardia
Am Heart J
(1930)
A Garson et al.
Supraventricular tachycardia in children: clinical features, response to treatment and long-term follow-up in 217 patients
J Pediatr
(1981)
GS Wolff et al.
Wolff-Parkinson-White syndrome in the neonate
Am J Cardiol
(1978)
ME Mantakas et al.
Natural history of Wolff-Parkinson-White syndrome discovered in infancy
Am J Cardiol
(1978)
BJ Deal et al.
Wolff-Parkinson-White syndrome and supraventricular tachycardia during infancy: management and follow-up
J Am Coll Cardiol
(1985)
BG Goel et al.
Manifestation of the Wolff-Parkinson-White syndrome after myocardial infarction
Am Heart J
(1974)
S Milstein et al.
Electrophysiologic profile of asymptomatic Wolff-Parkinson-White pattern
Am J Cardiol
(1986)

There are more references available in the full text version of this article.

Cited by (20)

Wolff–Parkinson–White and Preexcitation Syndromes
2017, Encyclopedia of Cardiovascular Research and Medicine
Preexcitation syndrome can be the cause of reentrant tachycardia; in this case it is called Wolff–Parkinson–White syndrome. The preferred treatment is often ablation of accessory pathway. The main problem is related to the risk of sudden death that might complicate the follow-up and be the first event in patients with asymptomatic preexcitation. The risk of sudden death remains rare and should be compared with the risks and success of ablation of accessory pathway. Generally, noninvasive studies are unable to correctly predict the risk. Electrophysiological study is the best means to detect the risk of sudden death, evaluate the nature of the symptoms, and discuss ablation.
Evolution of clinical and electrophysiologic data in patients with a preexcitation syndrome
2012, Journal of Electrocardiology
Citation Excerpt :
This was not the case for 1 girl of our population but also for an adult, who had a short AP refractory period and who lost the criteria of malignancy. Our study could not confirm the increased risk of AF with age reported in previous studies.6,7,16,27,31 However, the mean age of our patients at the second study remained relatively young (41 ± 17 years).
The purpose of the study is to report the natural changes of preexcitation syndrome (PS).
Electrophysiologic study was performed for syncope (n = 8), atrioventricular reentrant tachycardia (AVRT) (n = 42), atrial fibrillation (n = 3), adverse presentation (n = 4), or for asymptomatic PS (n = 22) and was repeated 1 to 21 years later.
Clinically, 12 patients initially asymptomatic became symptomatic (54.5%), and 12 symptomatic patients became asymptomatic (21%). At electrophysiologic study 2, maximal rate conducted over accessory pathway (AP) was slower. Anterograde conduction disappeared in 22 patients, but 10 of them had inducible AVRT. Among 27 patients with initially rapid conduction over AP, 7 had a benign form; 20 had always a rapid conduction over AP, and 3 of them initially asymptomatic developed rapid atrial fibrillation.
Asymptomatic patients with a PS frequently became symptomatic (54.5%), whereas symptomatic patients rarely became asymptomatic (21%). Maximal rate conducted over AP decreased during life, but AVRT remained inducible.
Wolff-Parkinson-White syndrome in the elderly: Clinical and electrophysiological findings
2008, Archives of Cardiovascular Diseases
Screening for Wolff-Parkinson-White (WPW) syndrome is recommended in children and young adults. The aim of this study was to evaluate the clinical and electrophysiological characteristics of patent WPW syndrome in subjects ≥60 years of age.
Four-hundred and fifty-nine consecutive patients with WPW syndrome, aged 8–80 years, were recruited; 32 (7%) of these patients were ≥60 years of age. The clinical, electrophysiological and therapeutic data for these patients were evaluated.
Sixteen men and 16 women, aged 60–81 years (67 ± 4.5), were admitted for resuscitated sudden death (1), rapid atrial fibrillation (4), syncope (4), or junctional tachycardia (13); 10 patients were asymptomatic (10). Left lateral bundles of Kent were detected more frequently in patients over 60 years (56%) than in those < 60 years of age (40.5%). Reciprocal tachycardia was induced in 58% of subjects <60 years of age and 53% of those ≥60 years old (difference not significant); atrial fibrillation was more frequent in subjects ≥ 60 years of age (37.5% vs. 19%) (p < 0.05). The incidence of malignant forms of WPW syndrome was identical in older and younger subjects. Ablation of the accessory pathway was indicated 18 times; effective ablation of a left bundle of Kent required a second intervention more often in patients ≥60 years of age (22% vs. 5%) (p < 0.05).
WPW syndrome is not uncommon in subjects over 60 years of age (7%). Left lateral accessory pathways, that have similar conduction properties to those in much younger subjects, are common. Ablation of the bundle of Kent is often difficult but is indicated in symptomatic subjects or those with more serious forms of WPW syndrome.
L’évaluation du syndrome de Wolff-Parkinson-White (WPW) est recommandée chez les enfants et les jeunes adultes. Le but de cette étude a été d’évaluer les caractéristiques cliniques et électrophysiologiques de sujets de plus de 60 ans ayant un WPW patent.
459 patients âgés de 8 à 80 ans ont été recrutés consécutivement pour un WPW. 32 d’entre eux avaient au moins 60 ans (7%). Leurs données cliniques, électrophysiologiques et thérapeutiques ont été évaluées.
16 hommes, 16 femmes âgés de 60 à 81 ans (67 ± 4,5) ont été admis pour une mort subite récupérée (1), une fibrillation auriculaire (FA) rapide (4), une syncope (4), des tachycardies jonctionnelles (13) ou étaient asymptomatiques (10). Le faisceau de Kent était plus souvent latéral gauche (56%) qu’avant 60 ans (40,5%). Une tachycardie réciproque a été induite chez 58 % des sujets avant 60 ans, 53 % après (NS), une FA plus fréquemment après qu’avant 60 ans (37,5% vs 19%) (p < 0,05). L’incidence des formes malignes a été identique avant et après 60 ans. L’ablation du faisceau de Kent, indiquée 18 fois a nécessité une 2^e procédure plus fréquemment après qu’avant 60 ans en cas de localisation gauche (22% vs 5%) (p < 0,05).
Le WPW n’est pas rare après 60 ans (7%). Il est souvent dû à un faisceau de Kent latéral gauche qui garde des propriétés de conduction similaires aux sujets plus jeunes. L’ablation du faisceau est souvent difficile mais est indiquée chez les sujets symptomatiques ou avec une forme grave.
Influence of age on the electrophysiological mechanism of paroxysmal supraventricular tachycardias
2001, International Journal of Cardiology
The purpose of this study was to evaluate the influence of age on the mechanism of paroxysmal supraventricular tachycardia (PSVT). Previous studies have shown age and sex differences between certain arrhythmias and especially changes in electrophysiological characteristics of Wolff–Parkinson–White syndrome. Four hundred and eighty five patients aged 9–86 years, with PSVT and without Wolff–Parkinson–White syndrome in sinus rhythm, were studied. The esophageal or intracardiac electrophysiological study used a standardized atrial pacing protocol. Paroxysmal junctional tachycardia was induced in 475 patients. The mechanism of tachycardia was not influenced by age and atrioventricular nodal reentrant tachycardia (AVNRT) was found as the main cause of PSVT in all ranges of age. Atrioventricular reentrant tachycardia (AVRT) using a concealed accessory pathway (AP) had a similar incidence from youth to elderly. The ratio male/female (M/F) and the inducibility of other arrhythmias (atrial flutter/fibrillation) (AF/AFl) were also found to be similar in all ranges of age. The age of the patients did not influence the mechanism of the tachycardia. Most of PVST were related to a AV nodal reentrant tachycardia. Concealed accessory pathway was identified with a similar incidence in young and old patients.
Accessory pathway and atrioventricular node reentrant tachycardia in elderly patients: Clinical features, electrophysiologic characteristics and results of radiofrequency ablation
1994, Journal of the American College of Cardiology
Objectives. This study was designed to evaluate the clinical features, electrophysiologic characteristics and results of radio-frequency ablation in elderly patients with accessory atrioventricular (AV) pathways or AV node reentrant tachycardia. Background. Radiofrequency ablation in elderly patients with paroxysmal supraventricular tachycardia has not been well described, and comparative study between elderly and younger patients is limited.
Methods. Electrophysiologic studies and radiofrequency ablation were performed in 92 elderly patients (45 with an accessory pathway, 47 with AV node reentrant tachycardia).
Results. The elderly patients had poorer electrophysiologic properties in accessory pathways and dual AV node pathways than those of younger patients. The success rate of radiofrequency ablation was similar in elderly and younger patients. However, elderly patients had more complications (14%) in left-sided accessory pathways.
Conclusions. Radiofrequency ablation in elderly patients with supraventricular tachycardia was effective. However, it must be performed cautiously in those patients with left-sided accessory pathways.
Clinical features and electrophysiologic characteristics of accessory atrioventricular pathways and atrioventricular nodal reentrant tachycardia: Comparative study between young and elderly patients
1993, American Heart Journal
Information focused on elderly patients with paroxysmal supraventricular tachycardia, and a comparative study between the elderly and younger patients was limited. The aim of this study was to investigate the clinical features and electrophysiologic characteristics in elderly patients (≥65 years of age) with accessory atrioventricular pathway-mediated tachyarrhythmia or atrioventricular nodal reentrant tachycardia. Electrophysiologic studies of 45 elderly patients with accessory pathway-mediated tachyarrhythmia and 47 elderly patients with atrioventricular nodal reentrant tachycardia were performed. When compared with younger patients, the elderly patients had a similar incidence of critical clinical manifestation, higher incidence of other cardiac disease or systemic disease, similar inducibility of tachycardia, greater baseline electrophysiologic parameters (sinus node, atrioventricular node, atrium and ventricle), and poorer properties of accessory pathways and dual atrioventricular nodal pathways. These results suggest that conduction properties of accessory pathways and dual atrioventricular nodal pathways were poorer in elderly patients, but similar critical manifestations and tachycardia events were found in elderly and younger patients.

View all citing articles on Scopus

View full text

Comparison of clinical and electrophysiologic features of preexcitation syndromes in patients presenting initially after age 50 years with those presenting at younger ages

Abstract

Am Heart J

J Pediatr

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

Am Heart J

Am J Cardiol