Ablation Therapy of Supraventricular Tachycardia in Elderly Persons

Leonard S. Dreifus, MD; Scott J. Pollak, MD


Am J Geriatr Cardiol. 2005;14(1):20-25. 

In This Article

AVRT Extranodal Accessory Pathways, WPW Syndrome, and Lown-Ganong-Levine Syndrome

These tachycardias can be extremely symptomatic but infrequently observed. However, in the presence of atrial fibrillation, the possibility of ventricular fibrillation can occur if the refractory period of the accessory pathway is <250 milliseconds[8,9] (Figure 3). Accessory pathways usually exhibit rapid nondetrimental conduction similar to the His-Purkinje pathways. Lown-Ganong-Levine tachycardias are rapid re-entrant supraventricular mechanisms. The basic and electrocardiogram tachycardias show an extremely short PR interval, and a narrow QRS without a delta wave. As in the case of the WPW syndrome, ventricular fibrillation can occur in the presence of atrial fibrillation. The diagnosis of WPW syndrome is reserved for those persons who have a combination of the WPW pattern and SVT. All symptomatic patients with a WPW electrocardiogram should undergo an electrophysiologic study for risk stratification. In Figure 3, atrial fibrillation was present in a case of WPW with varying wide QRS complexes. R-R intervals ≤250 milliseconds, as seen in V4, are associated with the risk of ventricular fibrillation.

Electrocardiogram of patient with Wolff-Parkinson-White syndrome showing atrial fibrillation and varying wide QRS complexes. R-R intervals ≤250 milliseconds as seen in V4 are associated with the risk of ventricular fibrillation.