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Risk stratification of high-risk accessory pathways in a patient with preexcitation syndrome by transesophageal electrophysiological study
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  • Chao Qin,
  • Tao He,
  • Shuo Li,
  • Hong Ruan
Chao Qin
Guangxi Medical University First Affiliated Hospital
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Tao He
Guangxi Medical University First Affiliated Hospital

Corresponding Author:[email protected]

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Shuo Li
Guangxi Medical University First Affiliated Hospital
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Hong Ruan
Guangxi Medical University First Affiliated Hospital
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Abstract

The patient is a 19-year-old man who often wakes up in dreams with palpitations and fatigue. The electrocardiogram shows: 1. Sinus rhythm; 2. Preexcitation syndrome. Transesophageal electrophysiological examination (TEEPS) showed that: 1. When the S1S1 stimulation frequency is set at 260bpm, the atrioventricular conduction still shows a descending ratio of 1:1; 2. When S1S2 was set to 500-220ms, the atrioventricular node entered the refractory period earlier than the accessory pathway, atrial stimulation was transmitted to the ventricle through the accessory pathway, and the QRS waveform showed a complete preexcitation pattern. TEEPS diagnosis:High-risk preexcitation syndrome bypass. During radiofrequency catheter ablation, the patient suddenly developed atrial fibrillation and quickly converted to ventricular fibrillation. After defibrillation, ventricular fibrillation is transformed into sinus rhythm. Subsequently, the patient’s high-risk accessory pathway was successfully ablated. Postoperative electrocardiogram: 1. Sinus rhythm; 2.ST segment elevation (early repolarization). Studies have shown that about 25% of patients with WPW syndrome have a refractory period of less than 250 ms, which is one of the risk factors for the conversion of atrial fibrillation to ventricular fibrillation. Therefore, risk stratification is recommended for these symptomatic patients. TEEPS and intracardiac electrophysiology play a similar role in risk stratification of preexcitation syndrome, but the former is easier to implement, lower cost and lower risk. The diagnosis of TEEPS is a high-risk bypass for preexcitation syndrome, which provides a strong basis for follow-up diagnosis and treatment. TEEPS is a simple, safe and reliable non-invasive cardiac electrophysiological detection technique.