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Biomedical subjects

G S Wolff

Publications and source records attributed to G S Wolff.

53 records · Page 3Linked to original sources
PubMed1981

Echocardiographic assessment of right bundle branch injury after repair of tetralogy of Fallot.

Nineteen patients, ages 3 1/2-18 years, with electrocardiographic evidence of right bundle branch injury after intracardiac repair of tetralogy of Fallot, underwent invasive intracardiac electrophysiologic evaluation 1-13 years (mean 4.4 years) postoperatively. Categorization of the site of right bundle branch injury as proximal or distal was made by determining the V-RVA interval. In 11 of the patients, the V RVA interval was prolonged (> 35 msec), indicating proximal right bundle branch injury and in the other eight it was normal (< 35 msec), indicating distal bundle branch injury. Within 24 hours of the study, all patients were studied by M-mode echocardiography. Measurements were made of the tricuspid valve closure, mitral valve closure and the difference between the two, or the delta value. All but one patient with distal bundle branch injury had delta values of less than 40 msec (range 8-38 msec), while 10 or 11 patients with proximal bundle branch injury had delta values greater than 40 msec (range 41-116 msec). there was a significant positive correlation (r = 0.74, p < 0.001) between V-RVA and the delta value. We conclude that the delta value is an indicator of relative activation delay of the right ventricle, and therefore, in most cases, proximal vs distal bundle branch injury can be diagnosed noninvasively.

Adolescent↗
PubMed1981

His-Purkinje responses and refractory periods during atrial extrastimulation in children with heart defects.

During atrial extrastimulation, split His potentials, prolonged His-to-ventricular (H2V2) intervals and block distal to the His bundle deflection were observed in both preoperative and postoperative children with heart defects. His-Purkinje responses and refractoriness were identified in 31 of 78 (40%) pediatric patients (20 of 51 preoperative and 11 of 27 postoperative) during atrial extrastimulation coupled to sinus and/or paced cycle lengths. Split His potentials were found in 14 patients (eight preoperative and six postoperative) and His bundle relative refractory periods ranged from 250--490 msec. Prolonged H2V2 intervals were found in these and in an additional 16 patients (11 preoperative and five postoperative) and the relative refractory period of the His-Purkinje system ranged from 230--500 msec. Block distal to the His deflection occurred in seven patients (five preoperative and two postoperative) and the effective refractory period ranged from 230--510 msec. Split His potentials, long H2V2 intervals and block distal to the His bundle deflection produced by atrial extrastimulation were found in peroperative as well as postoperative children. These responses probably represent functional electrophysiologic characteristics of the pediatric cardiac conduction system.

Adolescent↗
PubMed1980

Dual atrioventricular nodal pathways: a benign finding in arrhythmia-free children with heart disease.

The incidence and significance of dual atrioventricular (A-V) nodal pathways are described in 78 children with associated congenital or acquired heart disease. None of these patients had clinical or electrocardiographic evidence of arrhythmia. Dual A-V nodal pathways were observed in 35 percent of the preoperative group and in 33 percent of the postoperative group. Despite this substrate for A-V nodal reentry, supraventricular tachycardia was neither induced during electrophysiologic evaluation nor did it develop clinically over a follow-up period of 1 month to 15 years. It is concluded that dual A-V nodal pathways are common and may be a benign finding in arrhythmia-free children with heart disease.

Adolescent↗
PubMed1979

The fast-slow form of atrioventricular nodal reentrant tachycardia in children.

An unusual form of atrioventricular (A-V) nodal reentry is described as the underlying mechanism for incessant tachycardia in two children. During tachycardia a fast pathway was utilized for anterograde conduction and a slow pathway for retrograde conduction. This is the reverse of the usual form of A-V nodal reentrant tachycardia, in which the slow pathway is utilized for anterograde conduction and the fast pathway for retrograde conduction. One patient had a smooth ventriculoatrial (V-A) conduction curve demonstrating exclusive utilization of the slow pathway for retrograde conduction. The other had a discontinuous V-A conduction curve demonstrating failure of retrograde fast pathway conduction with resultant slow pathway conduction. In both cases the retrograde effective refractory period of the fast pathway was longer than that of the slow pathway, resulting in the establishment of this unusual reentry circuit. Both patients had a superior P axis with a P-R interval shorter than the R-P interval during tachycardia, features described in a significant number of children with incessant tachycardia. This unusual form of reentrant tachycardia can be suggested by its electrocardiographic pattern and is another mechanism for reentrant tachycardia not previously documented in children.

Atrioventricular Node↗
PubMed1978

Wolff-Parkinson-White syndrome in the neonate.

Of 16 infants who presented with paroxysmal supraventricular tachycardia in the neonatal period, 50 percent had an electrocardiographic pattern consistent with Wolff-Parkinson-White conduction, type A. It is suggested that infants have bypass pathways similar to or identical with a Kent pathway as part of normal maturation. Infants with paroxysmal supraventricular tachycardia have electrically active bypass tracts but these are documented in only about one half of the patients because of the short duration of recordings or because of concealment (the bypass tract conducts only in retrograde fashion). The activity of these pathways is enhanced by the predominant cholinergic innervation of the neonatal heart. Resolution of the arrhythmias and the Wolff-Parkinson-White pattern in most patients occurs because of anatomic maturation of the conduction tissue, development of adrenergic innervation and a decrease in cholinergic dominance. In some children, maturation is incomplete and the bypass fibers remain quiescent or become active under certain circumstances such as those associated with increased autonomic discharge. Extended surveillance is recommended for all infants who present with paroxysmal supraventricular tachycardia and the Wolff-Parkinson-White pattern.

Child, Preschool↗
PubMed1977

Intraoperative identification of the conduction system in repair of endocardial cushion defect.

Electrophysiological identification intraoperatively of the His-Purkinje system eliminates the complication of complete heart block consequent upon repair of endocardial cushion defect (ECD). Ten patients, 6 with complete ECD and 4 with incomplete ECD, underwent repair of the defect. None of the patients developed heart block. Slight variations were noted in the location of the His bundle in 9 patients, and a major deviation was found in 1 patient with incomplete ECD. The data support the use of intraoperative recordings as a necessary acconpaniment to the operative repair of ECD.

Bundle of His↗
PubMedDate not supplied

Benign nature of atrial dissociation in pediatric patients.

Atrial dissociation is defined electrocardiographically by the presence of an ectopic atrial rhythm depolarizing independently of the basic sinus rhythm, and is characterized by entrance and exit block. Atrial dissociation is most often observed as an ominous sign in adults with severe myocardial dysfunction. We have observed atrial dissociation in 3 pediatric patients, aged 5 to 22 years, who were essentially asymptomatic from this arrhythmia. All 3 patients are well, without therapy for atrial dissociation, during a follow-up period of 1 to 5 years. The benign nature of atrial dissociation in the pediatric patient as compared with the adult is stressed.

Adolescent↗
PubMedDate not supplied

Cardiologic assessment in participants of Pop Warner Junior League football.

Physical examinations and electrocardiograms were performed on 50 young men in preseason training for Pop Warner Football. Functional murmurs were found in 52%. The majority of electrocardiographic findings were within the accepted normal range for nonathletes but some were consistent with findings in trained athletes. Awareness of these normal variations is important for proper assessment of prospective and participating athletes.

Adolescent↗