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Pre-excitation syndrome and hypertrophic cardiomyopathy
Insights
The association between hypertrophic cardiomyopathy (HC) and pre-excitation (PE) syndrome is common. Patients with HC and PE show similar rates of paroxysmal tachycardias as those with PE alone.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiovascular Diseases
Background:
- Pre-excitation (PE) syndrome and hypertrophic cardiomyopathy (HC) are distinct cardiac conditions.
- Understanding the co-occurrence of these conditions is crucial for patient management.
Purpose of the Study:
- To investigate the incidence and characteristics of pre-excitation syndrome associated with hypertrophic cardiomyopathy.
- To analyze the prevalence of paroxysmal tachycardias in patients with coexisting HC and PE.
- To identify specific electrocardiographic and vectorcardiographic patterns in the HC-WPW association.
Main Methods:
- Retrospective analysis of 105 consecutive patients with pre-excitation syndrome over 10 years.
- Detailed assessment of cardiac conditions, including hypertrophic cardiomyopathy, coronary heart disease, and hypertensive heart disease.
- Evaluation of electrocardiograms (ECGs) and vectorcardiograms (VCGs) for specific patterns.
Main Results:
- Eight patients (7.62%) presented with associated hypertrophic cardiomyopathy.
- The incidence of paroxysmal tachycardias was 56.2% in the total PE group and 62.5% in the HC-PE subgroup.
- Specific ECG/VCG patterns, including incomplete left bundle branch block and left ventricular hypertrophy, were observed in the HC-WPW association.
Conclusions:
- The association between hypertrophic cardiomyopathy and pre-excitation syndrome is not infrequent.
- Paroxysmal tachycardia incidence in the HC-PE subgroup is comparable to isolated PE.
- Electrocardiographic and vectorcardiographic findings in HC-WPW type PE are highly specific.
Abstract:
Among one hundred and five consecutive patients with pre-excitation (PE) syndrome studied during a 10-year period, eight had an associated hypertrophic cardiomyopathy (HC) (7.62 per cent), eight had a coronary heart disease (7.62 per cent) and nine had a hypertensive heart disease (8.57 per cent). Of the eight patients with HC, four had an asymmetrical form (three of them with an obstructive component), and four a symmetrical form. Seven of these patients had a Wolff-Parkinson-White (WPW) type of PE and the remainder a Lown-Ganong-Levine type of PE. The incidence of paroxysmal tachycardias in the total group was 56.2% (61/105) and in the patients with associated HC was 62.5% (5/8). One of these latter patients had a concomitant brady-tachy syndrome and a severe obstructive form of HC. He was surgically treated (septal myomectomy and section of accessory atrioventricular pathway). The ECGs and VCGs of the seven patients with the HC-WPW type of PE association showed the coexistence of incomplete left bundle branch block of left ventricular hypertrophy patterns. The eight patients with associated HC were closely followed up from two to seven years (total follow-up period 435 patient/months). One of them died suddenly during the 40th month of follow-up. This study suggests that: 1) HC-PE association is not infrequent; 2) the incidence of paroxysmal tachycardias in the subgroup is quite similar to that presented in isolated PE; and 3) the electrocardiographic and vectorcardiographic changes in the HC-WPW type of PE association are highly specific.