VENTRICULAR-FIBRILLATION IN THE WOLFF-PARKINSON-WHITE SYNDROME

To examine the risk of ventricular fibrillation in patients with the Wolff-Parkinson-White syndrome, we compared patients who had this syndrome and a history of ventricular fibrillation related to preexcitation with patients who had the syndrome without this history. Ventricular fibrillation occurred during atrial fibrillation, with rapid conduction over the accessory pathway, and these patients had a higher prevalence of both reciprocating tachycardia and atrial fibrillation (14 of 25 vs. 18 of 73, P = 0.004) and multiple accessory pathways (five of 25 vs. four of 73, P = 0.012). The shortest preexcitation R-R interval during atrial fibrillation was less in the group with ventricular fibrillation (mean shortest R-R, 180 vs. 240 milliseconds, P<0.0001) as was the average R-R interval (mean average R-R, 269 vs. 340 milliseconds, P<0.0001). Patients with Wolff-Parkinson-White syndrome who are most susceptible to ventricular fibrillation have a history of atrial fibrillation and reciprocating tachycardia, demonstrate rapid conduction over an accessory pathway during atrial fibrillation and have multiple accessory pathways. (N Engl J Med 301:1080–1085, 1979) VENTRICULAR fibrillation is a life-threatening development within the spectrum of arrhythmias associated with the Wolff-Parkinson-White syndrome.1 2 3 4 5 This arrhythmia generally occurs when patients are in atrial fibrillation, with very rapid conduction to the ventricles over an accessory atrioventricular pathway. This report proposes some guidelines for assessing the risk of ventricular fibrillation in symptomatic patients with the Wolff-Parkinson-White syndrome.4 5 6 7 8 9 10 These guidelines are based on clinical and electrophysiologic findings in 31 patients referred for assessment of ventricular fibrillation associated with the Wolff-Parkinson-White syndrome. Methods Patient Population The patients were selected from those referred to the Clinical Electrophysiology Laboratory at Duke University Medical Center. © 1979, Massachusetts Medical Society. All rights reserved.