Gender and atrioventricular conduction properties of patients with symptomatic atrioventricular nodal reentrant tachycardia and Wolff-Parkinson-White syndrome

doi:10.1054/jelc.2001.26316

Journal of Electrocardiology

Volume 34, Issue 4, October 2001, Pages 295-301

https://doi.org/10.1054/jelc.2001.26316 Get rights and content

Abstract

The objective of this study was to delineate the sex distribution and atrioventricular conduction properties in patients with manifest or concealed Wolff-Parkinson-White syndrome (WPW) and atrioventricular nodal reentrant tachycardia (AVNRT). The study comprised 328 patients with AVNRT, 347 with manifest, and 220 with concealed WPW who underwent radiofrequency ablation. A male preponderance was observed in patients with manifest WPW (69%), but not in those with concealed WPW (52%) and female preponderance in AVNRT patients (67%). The PR (166 [plusmn] 25 ms) and AH (88 [plusmn] 20 ms) intervals obtained 30 minutes after ablation in manifest WPW patients were significantly longer than in concealed WPW patients (149 [plusmn] 20, 76 [plusmn] 15 ms, P [lt ] .0001). The PR (146 [plusmn] 20 ms) and AH intervals (75 [plusmn] 15 ms) measured before ablation in AVNRT patients were shorter than those obtained before ablation in concealed WPW patients (154 [plusmn] 21, 80 [plusmn] 17 ms, P [lt ] .05) and after ablation in manifest WPW patients (P [lt ] .0001). The PR interval in AVNRT patients was also shorter than those measured during follow-up in concealed (153 [plusmn] 21 ms, P [lt ] .05) and manifest WPW patients (165 [plusmn] 23 ms, P [lt ] .0001). The ventriculoatrial block cycle length in AVNRT patients was significantly shorter than in manifest and concealed WPW patients. When age-matched patients were assigned to each group, significant differences in PR interval were observed between men and women (159 [plusmn] 22 vs. 151 [plusmn] 22 ms, P [lt ] .0001). Differences in sex distribution exist among patients with manifest and concealed WPW and AVNRT. The atrioventricular conduction properties required for the manifestation of pre-excitation and induction of AVNRT and gender differences in atrioventricular conduction may account for the differences in sex distribution.

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Cited by (32)

Pediatric T-wave memory after accessory pathway ablation in Wolff-Parkinson-White syndrome
2022, Heart Rhythm
Citation Excerpt :
Alternate P values, if used, are specifically noted. Patient characteristics were similar between URAP and WPW cohorts; however, a male predominance was noted in both groups, which has been previously reported.21 There was no statistical difference with regard to mean age at ablation, type of energy, and number or duration of lesions (Table 1).
Altered ventricular depolarization due to manifest accessory pathway conduction (ie, Wolff-Parkinson-White syndrome) leads to repolarization abnormalities that persist after pathway ablation. The term T-wave memory (TWM) has been applied to these changes, as the postablation T-wave vector “remembers” the pre-excited QRS vector. In adults, these abnormalities can be misinterpreted as ischemia leading to unnecessary interventions. To date, no comprehensive studies have evaluated this phenomenon in the pediatric population.
The purpose of this study was to define TWM in the pediatric population, identify preablation risk factors, and delineate the timeline of recovery.
Pre- and postablation electrocardiograms (ECGs) in patients ≤25 years were analyzed over a 5-year period. Frontal plane QTc interval, T-wave axis, QRST angle, and T-wave inversions were used to identify patients with TWM. Univariate analysis was performed to determine the association of preablation ECG features with the outcome of TWM.
TWM was present in 42% of pediatric patients, with resolution occurring within 3 months of ablation. Preablation QRS axis <0° was a strong predictor of TWM (odds ratio [OR] 15.2; 95% confidence interval [CI] 5.7–40), followed by posteroseptal pathway location (right posteroseptal—OR 8.9; 95% CI 4.2–18.8; left posteroseptal—OR 6.1; 95% CI 1.7–22.3). The degree of pre-excitation had a modest association with the development of TWM. No adverse events were observed.
TWM is less common in children compared to adults, and normalization occurred within 3 months postablation. The most predictive features for the development of TWM include a leftward pre-excited QRS axis and posteroseptal pathway location.
Correlation of accessory pathway location with gender and their manifest or concealed presentation
2016, International Journal of Cardiology
Citation Excerpt :
This can be explained by hormonal differences, changes in the expression of the ionic channels, and by modifications in the autonomic tone. A higher incidence of manifest AP in adult males in comparison to adult females is also described [1,3,5–8]. The objective of this study is to evaluate the correlation of AP location with the male and female genders and AP form of presentation, whether manifest or concealed.
Atrioventricular reentrant tachycardias account for approximately one third of cases referred for electrophysiological study (EPS). The anatomical substrate responsible for the reentry is an accessory pathway (AP) able to conduct the electrical stimulus in an anterograde, retrograde or bidirectional manner.
To evaluate the correlation of AP location with the male and female genders and AP clinical presentation, whether manifest or concealed.
Retrospective observational study including 942 consecutive patients, all diagnosed with EPS-confirmed AP from January 1994 to December 2008. APs were classified into eight anatomical groups: left lateral (LL), left posterior (LP), left posteroseptal (LPS), right posteroseptal (RPS), right midseptal (RMS), right anteroseptal (RAS), right lateral (RL), and right posterior (RP).
Of the 942 patients, 52.6% were males. The mean age was 31.2 ± 13.8 years. As regards gender, APs were more prevalent among men. However, a statistically significant difference was observed only in the LPS (p = 0.029) and RL (p = 0.003) regions. In relation to the form of presentation of AP, the manifest form was more frequent than the concealed form in six of the eight regions studied, except for the LL and LPS regions.
AP predominated in males and the manifest form was more frequent than the concealed form in most of the regions studied.
2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society
2016, Journal of the American College of Cardiology
Citation Excerpt :
In contrast, in a study conducted in pediatric populations, the mean ages of symptom onset of AVRT and AVNRT were 8 and 11 years, respectively (53). In comparison with AVRT, patients with AVNRT are more likely to be female, with an age of onset >30 years (49,54–56). AVNRT onset has been reported after the age of 50 years in 16% and before the age of 20 years in 18% (57).
2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society
2016, Journal of the American College of Cardiology
2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society
2016, Heart Rhythm
Citation Excerpt :
In contrast, in a study conducted in pediatric populations, the mean ages of symptom onset of AVRT and AVNRT were 8 and 11 years, respectively.53 In comparison with AVRT, patients with AVNRT are more likely to be female, with an age of onset >30 years.49,54–56 AVNRT onset has been reported after the age of 50 years in 16% and before the age of 20 years in 18%.57
2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: Executive summary A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society
2016, Heart Rhythm

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^☆: This study is supported in part by funds from the Swedish Heart-Lung Foundation and Biosense Webster Europe.

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Gender and atrioventricular conduction properties of patients with symptomatic atrioventricular nodal reentrant tachycardia and Wolff-Parkinson-White syndrome☆

Abstract