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Accessory atrioventricular pathway, supra-, and infrahisian conduction impaired due to mitral annulus calcification
M Kriwisky1, J Goldstein, M S Gotsman
1Department of Cardiology, Hadassah University Hospital, Jerusalem, Israel.
Abstract:
Disorders of conduction occurring simultaneously in both normal and accessory pathways of patients with Wolff-Parkinson-White (WPW) syndrome have only rarely been observed. To our knowledge this is the first report of impaired conduction in both pathways in WPW syndrome due to mitral annulus calcification (MAC). This case of WPW syndrome type A presented the following conduction abnormalities: (1) right bundle-branch block; (2) transient second-degree AV block with prolonged PR interval of the conducted beats; (3) during electrophysiological study, induction of tachycardia, dependent (phase 3) second-degree AV block, and occasionally conduction of two consecutive beats, the second showing an increased H-V interval (from 25 to 60 ms) and left bundle-branch block (LBBB) pattern, due to (4) infrahisian conduction abnormality.
Insights
This is the first reported case of Wolff-Parkinson-White (WPW) syndrome with conduction abnormalities in both normal and accessory pathways, caused by mitral annulus calcification (MAC). The patient experienced right bundle-branch block and infrahisian conduction issues.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Pathology
Background:
- Wolff-Parkinson-White (WPW) syndrome involves accessory electrical pathways in the heart.
- Conduction disorders in both normal and accessory pathways are rare in WPW syndrome.
Observation:
- A rare case of WPW syndrome type A was observed.
- The patient presented with mitral annulus calcification (MAC).
Findings:
- Simultaneous conduction abnormalities in normal and accessory pathways were noted.
- Specific findings included right bundle-branch block, transient second-degree AV block, and infrahisian conduction abnormality.
- Electrophysiological study revealed phase 3 second-degree AV block and left bundle-branch block patterns.
Implications:
- This case highlights a novel association between MAC and complex conduction defects in WPW syndrome.
- Understanding these combined pathway abnormalities is crucial for accurate diagnosis and management.
- Further research may elucidate the mechanisms linking MAC to infrahisian conduction issues in WPW patients.