How to treat preexcitation syndrome?

summary

Preexcitation is an abnormal phenomenon of atrioventricular conduction. Impulses are transmitted down through additional channels to excite part or all of the ventricles in advance, causing part of the ventricular muscles to excite in advance, which is called "preexcitation". The author of this paper calls preexcitation syndrome complicated with supraventricular tachycardia. Preexcitation is a rare arrhythmia, the diagnosis mainly depends on ECG. How to treat preexcitation? Next, I'd like to share my opinions with you. Syndrome?

How to treat preexcitation syndrome?

Pre excitation itself does not need special treatment. When complicated with supraventricular tachycardia, the treatment is the same as general supraventricular tachycardia. When complicated with atrial fibrillation or atrial flutter, if the ventricular rate is fast and accompanied by circulatory disturbance, synchronous direct current cardioversion should be adopted as soon as possible.

Digitalis can accelerate the bypass conduction, verapamil and propranolol can slow down the atrioventricular nodal conduction, which may significantly increase the ventricular rate and even develop into ventricular fibrillation, so it is not suitable for use. If the attack of supraventricular tachycardia or atrial fibrillation or atrial flutter is frequent, the above antiarrhythmic drugs should be taken orally for a long time to prevent the attack.

For those who can not be controlled by drugs, whose refractory period is short by electrophysiological examination, or whose refractory period is shortened during rapid atrial pacing, or whose ventricular rate reaches about 200 beats / min during atrial fibrillation attack, there are indications to ablate by electric, radio frequency, laser or cryoablation after localization, or cut off the bypass by operation.

matters needing attention

In order to effectively prevent the recurrence of tachycardia, two drugs should be used to inhibit the forward and reverse conduction of reentry circuit at the same time, such as quinidine and propranolol, or procaine amine combined with verapamil, which can obtain better effect, Amiodarone or sol, an IC drug, can effectively prevent the recurrence of tachycardia by prolonging the irregularity of atrioventricular bypass and atrioventricular node. The choice of drugs can be based on clinical experience or ECG physiological examination, so as to ensure the best effect of preventing recurrence.