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

Abstract

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.

PACES/HRS expert consensus statement on the use of catheter ablation in children and patients with congenital heart disease

“…82 It is important to note that the dysfunction resolves in most cases after AP ablation, sometimes immediately, suggesting it is a direct effect of the eccentric activation and might or might not represent dyssynchrony-induced cardiomyopathy. [81][82][83][84][85] A number of these reports demonstrating improvement after ablation have been published since the 2012 guidelines for asymptomatic WPW, leading to a change in the guidelines' recommendation for ablation in patients with dyssynchrony presumed due to ventricular preexcitation from Class IIb to Class IIa.…”

Radionuclide Assessment of Cardiac Function and Dyssynchrony in Children with Idiopathic Ventricular Tachycardia

“…Answering this question requires further studies. Available literature presents the reports regarding the temporal changes in IVD after catheter treatment of atrial fibrillation 15 and ablation of accessory atrioventricular pathways. 16,17 At the same time, to our knowledge, available literature does not describe the changes in the parameters of intraventricular dyssynchrony in children with idiopathic VA.…”

Diagnosis and treatment of fetal and pediatric age patients (0–12 years) with Wolff–Parkinson–White syndrome and atrioventricular accessory pathways

“…Right-sided preexcitation, which manifests on ECG with a left bundle branch block appearance, may rarely cause ventricular dyssynchrony and left ventricular dysfunction, which resolves in most cases after ablation of the AP 82–87 …”