Assessment of accessory atrioventricular pathways by Doppler myocardial imaging.
OBJECTIVE
The use of electrophysiologic studies (EPS) for the localization of accessory atrioventricular connections in Wolff-Parkinson-White syndrome (WPW) requires accurate evaluation of the site of bypass tract insertion. Doppler myocardial imaging (DMI) is a new ultrasound technique that allows the detection of abnormal and early regional myocardial depolarization. The purpose of this study was to identify an abnormal pathway site in WPW patients.


METHODS
Twenty-one patients with ventricular preexcitation were studied by DMI. Two-dimensional color DMI, velocity maps, acceleration maps, and pulsed-wave applications were used. A subsequent diagnostic EPS was performed. The results of EPS were taken as the gold standard diagnostic procedure. Radiofrequency catheter ablation therapy was then performed on all patients.


RESULTS
The anomalous pathway was detected by DMI in 16 (76%) of 21 patients (9 [90%] of 10 with left pathways and 7 [64%] of 11 with right pathways), with respect to results of the EPS. Pathway detection was better with pulsed-wave DMI (76%) with its higher temporal resolution as compared with M-mode velocity map (57%) and acceleration map (47%). In most of the patients with successful radiofrequency ablation, an immediate resolution of the abnormal ventricular depolarization occurred and was detectable by DMI.


CONCLUSIONS
Our findings demonstrate the feasibility of DMI to assess the early ventricular contraction associated with atrioventricular accessory pathways. Therefore, DMI appears to be a clinically useful adjunct to noninvasive evaluation of abnormal myocardial depolarization in WPW and to evaluate the results after radiofrequency ablation, even though its accuracy is considerably better for left-sided accessory pathways than for right-sided ones.
Caso
Pio
P
Division of Cardiology, Monaldi Hospital, Naples, Italy. PIO.CASO@TIN.IT
D'Andrea
Antonello
A
Musto
Carmine
C
Nardi
Stefano
S
Cavallaro
Ciro
C
Martiniello
Alfonso Roberto
AR
Vecchione
Filippo
F
Mininni
Nicola
N
Calabrò
Raffaele
R
Sutherland
George R
GR
D000328:Adult; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000379:methods*; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D018619:Echocardiography, Doppler, Pulsed / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D004594:Electrophysiology; D005260:Female; D006329:Heart Conduction System / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D012016:Reference Values; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology; D018879:Ventricular Premature Complexes / Q000000981:diagnostic imaging*; D014927:Wolff-Parkinson-White Syndrome / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*