Decreased amplitude of left ventricular posterior wall motion with notch movement to determine the left posterior septal accessory pathway in Wolff-Parkinson-White syndrome

Hina, Kazuyoshi; Murakami, Toshimi; Kusachi, Shozo; Hirami, Ryouichi; Matano, Sakae; Ohnishi, Nobuhiko; Iwasaki, Kohichiro; Kita, Toru; Sakakibara, Noburu; Tsuji, Takao

doi:10.1136/hrt.82.6.731

Cited by 8 publications

(20 citation statements)

References 17 publications

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“…Other methods that have been employed to detect the AP include M-mode echocardiography, phase analysis of 2-dimensional echocardiographic images, Doppler myocardial imaging, and TDI. [10][11][12][13][14][15][16][17] These methods have focused mainly on abnormal ventricular motion. Previous authors have, for example, analyzed the time-sequential changes in ventricular wall motion in WPW syndrome using TDI in their studies.…”

Section: Discussionmentioning

confidence: 99%

Localization of Accessory Pathway Using Tissue Doppler Echocardiography Prior Radiofrequency Ablation in Patients with Wolff-Parkinson-White Syndrome

Gül¹,

Eksik²,

Surgit³

et al. 2017

Turkiye Klinikleri J Cardiovasc Sci

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A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : We sought to examine the diagnostic accuracy of tissue Doppler imaging (TDI) for the localization of the accessory pathways (APs) in Wolff-Parkinson-White (WPW) syndrome. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : We prospectively studied 35 patients with evidence of pre-excitation on electrocardiography. Patients were categorized into three groups according to the site of the AP: left ventricular free wall; septal; and right ventricular free wall. The recordings obtained using TDI from the lateral mitral annulus, septal annulus, and lateral tricuspid annulus were respectively compared with the electrophysiological study (EPS) results for the location of the AP. Electromechanical interval (p-Sm) was defined as the time difference between the onset of the p wave and the onset of regional myocardial contraction (Sm) on echocardiography. R Re es su ul lt ts s: : In patients with left free access in EPS, electromechanical interval (pre-p-Sm) in the lateral mitral annulus was significantly shorter in the other two regions (septal annulus, and lateral tricuspid annulus) in TDI before treatment (p=0.0001). In patients with septal AP and right free AP detected at EPS, the pre-p-Sm interval was shorter, respectively, at the septal annulus and lateral tricuspid annulus, but was not statistically significant, due to the small numbers of patients in both regions. C Co on nc cl lu us si io on n: : The p-Sm interval in TDI before the ablation procedure, specifically in patients having a left free AP, was found to be short due to early stimulus. This was especially detected without using a free electrocardiogram (ECG) algorithm. The prediction of AP in TDI may play an important role in planning and performing the radiofrequency catheter ablation (RFCA).K Ke ey yw wo or rd ds s: : Wolff-Parkinson-White syndrome; echocardiography, Doppler Ö ÖZ ZE ET T A Am ma aç ç: : Wolff-Parkinson-White (WPW) sendromundaki aksesuar yolların (AP'ler) lokalizasyonu için doku Doppler görüntülemenin (TDI) tanısal doğruluğunu incelemeye çalıştık. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : EKG'sinde preeksitasyonu olan 35 hastayı prospektif olarak inceledik. Hastalar aksesuar yolun sol ventrikül serbest, septal ve sağ ventrikül serbest duvar olmak üzere üç gruba ayrıldı. TDI'da hastaların lateral mitral annulus, septal mitral annulus ve lateral triküspit annulustan alınan kayıtlar, elektrofizyolojik çalışma (EPS) da aksesuar yolun olduğu bölgelerle karşılaştırıldı. Ekokardiyografik incelemedeki elektromekanik interval (p-Sm) p dalgasının başlangıcı ile bölgesel miyokard kasılması (Sm) arasında geçen zaman olarak tanımlandı. B Bu ul lg gu ul la ar r: : EPS'de sol serbest aksesuar yol izlenen hastalarda, işlem öncesi TDI'da lateral mitral annulusta elektromekanik interval (pre p-Sm) diğer iki bölgeden (septal annulus ve sağ lateral triküspit annulus) anlamlı şekilde daha kısa saptandı (p=0.0001). EPS'de septal aksesuar yol saptanan ve sağ aksesuar yol saptanan hastalar...

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Section: Discussionmentioning

confidence: 99%

Localization of Accessory Pathway Using Tissue Doppler Echocardiography Prior Radiofrequency Ablation in Patients with Wolff-Parkinson-White Syndrome

Gül¹,

Eksik²,

Surgit³

et al. 2017

Turkiye Klinikleri J Cardiovasc Sci

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“…In some patients with Type A WPW, this early anterior motion is accompanied by paradoxical anterior motion of the interventricular septum [28]. It has been reported that the amplitude of LV posterior systolic wall motion is reduced when the pathway is located on the LV side, especially with left posterior septal accessory pathway [29].…”

Section: M-mode Echocardiographymentioning

confidence: 99%

The use of echocardiography in Wolff–Parkinson–White syndrome

Cai

Shuraih

Nagueh

2011

Int J Cardiovasc Imaging

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Endocardial mapping and radiofrequency catheter ablation are well established modalities for the diagnosis and treatment of patients with Wolff-Parkinson-White (WPW) syndrome associated with tachyarrhythmias. However, the electrophysiologic techniques are invasive, require radiation exposure, and lack spatial resolution of cardiac structures. A variety of echocardiographic techniques have been investigated as a non-invasive alternative for accessory pathway localization. Conventional M-mode echocardiography can detect the fine premature wall motion abnormalities associated with WPW syndrome. However, it is unable to identify the exact site of accessory pathway with sufficient accuracy. 2D, 2D-guided M-mode, and 2D phase analysis techniques are limited by image quality and endocardial border definition. Various modalities of tissue Doppler echocardiography significantly increase the accuracy of left-sided accessory pathway localization to 80-90% even in patients with poor acoustic window. However, right-sided pathways remain a diagnostic challenge. Strain echocardiography by speckle tracking has recently been evaluated and appears promising. Different cardiac abnormalities have been detected by echocardiography in WPW patients. Patients with WPW syndrome and tachyarrhythmias have impaired systolic and diastolic function which improves after radiofrequency ablation. Echocardiography is useful in identifying patient with accessory pathway-associated left ventricular dyssynchrony and dysfunction who may benefit from ablation therapy. Transesophageal and intracardiac echocardiography have been used to guide ablation procedure. Ablation-related complications detected by routine echocardiography are infrequent, rarely clinically relevant, and of limited value.

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“…Earlier echocardiographic studies demonstrated that left posteroseptal accessory pathways are associated with abnormal left ventricular posterior wall motion [1–3] and that right anterior or right posteroseptal pathways produce abnormal interventricular septal motion [2, 4–6]. Since these studies predated the era of catheter ablation, localization of accessory pathways was based solely on electrocardiographic criteria [7].…”

Section: Introductionmentioning

confidence: 99%

Ventricular Dyssynchrony and Function Improve following Catheter Ablation of Nonseptal Accessory Pathways in Children

Abadir

Fournier

Dubuc

et al. 2013

BioMed Research International

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Introduction. Paradoxical or hypokinetic interventricular septal motion has been described in patients with septal or paraseptal accessory pathways. Data regarding nonseptal pathways is limited. Methods and Results. We quantified left ventricular dyssynchrony and function in 16 consecutive children, 14.2 ± 3.7 years, weighing 53 ± 17 kg, prior to and following catheter ablation of bidirectional septal (N = 6) and nonseptal (N = 10) accessory pathways. Following ablation, the left ventricular ejection fraction increased by 4.9 ± 2.1% (P = 0.038) from a baseline value of 57.0% ± 7.8%. By tissue Doppler imaging, the interval between QRS onset and peak systolic velocity (Ts) decreased from a median of 33.0 ms to 18.0 ms (P = 0.013). The left ventricular ejection fraction increased to a greater extent following catheter ablation of nonseptal (5.9% ± 2.6%, P = 0.023) versus septal (2.5% ± 4.1%, P = 0.461) pathways. The four patients with an ejection fraction <50%, two of whom had left lateral pathways, improved to >50% after ablation. Similarly, the improvement in dyssynchrony was more marked in patients with nonseptal versus septal pathways (difference between septal and lateral wall motion delay before and after ablation 20.6 ± 7.1 ms (P = 0.015) versus 1.4 ± 11.4 ms (P = 0.655)). Conclusion. Left ventricular systolic function and dyssynchrony improve after ablation of antegrade-conducting accessory pathways in children, with more pronounced changes noted for nonseptal pathways.

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Decreased amplitude of left ventricular posterior wall motion with notch movement to determine the left posterior septal accessory pathway in Wolff-Parkinson-White syndrome

Abstract: (Heart 1999;82:731-739)

Cited by 8 publications

References 17 publications

Localization of Accessory Pathway Using Tissue Doppler Echocardiography Prior Radiofrequency Ablation in Patients with Wolff-Parkinson-White Syndrome

Localization of Accessory Pathway Using Tissue Doppler Echocardiography Prior Radiofrequency Ablation in Patients with Wolff-Parkinson-White Syndrome

The use of echocardiography in Wolff–Parkinson–White syndrome

Ventricular Dyssynchrony and Function Improve following Catheter Ablation of Nonseptal Accessory Pathways in Children

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