Abstract
It was our clinical impression that ECG evidence of pre-excitation (PE) is found more commonly in pts with tricuspid atresia (TA) than previously reported (0.29-1.3%). We attempted to determine a) the incidence of PE by surface ECG in pts with TA and b) if this represents the presence of a true accessory pathway.
Surface ECGs from 183 consecutive pts with TA evaluated at the Mayo Clinic between 1981-1986 were reviewed by 3 pediatric cardiologists for evidence of PE. The patients' ages ranged from 4/12 to 21 years. The M:F ratio was 5:4. PE was diagnosed if the PR interval (PR) was ≤.10 seconds, the QRS was ≥.10 seconds and a delta wave was present. Of the 183 pts, 22 (12%) had PR ≤.10 seconds and 9 pts (5%; 6F, 3M) fulfilled criteria for PE, 5 of which had a history of SVT. Four of the 5 pts had invasive electrophysiologic studies (EPS) performed. Only 1 pt had an accessory pathway, but 2 had enhanced AV node conduction and 1 had normal AV node conduction.
We conclude: 1) surface ECG evidence for PE in pts with TA is more common (5%) than previously reported. 2) Apparent PE can be due to an accessory pathway or enhanced AV node conduction (in combination with LVH). 3) Patients with TA being considered for intracardiac repair should have their ECG reviewed carefully for apparent PE; if found, especially in the presence of SVT, they should undergo EPS to determine the presence and location of an accessory pathway for surgical ablation.
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Zellers, T., Driscpll, D. & Porter, CB. APPARENT PRE-EXCITATION IN TRICUSPID ATRESIA. Pediatr Res 21 (Suppl 4), 197 (1987). https://doi.org/10.1203/00006450-198704010-00183
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DOI: https://doi.org/10.1203/00006450-198704010-00183