title: Noninvasive localization of accessory pathways in patients with wolff-Parkinson-white syndrome: a strain imaging study.
abstract: BACKGROUND
  Noninvasive techniques for the localization of the accessory pathways (APs) might help guide mapping procedures and ablation techniques. We sought to examine the diagnostic accuracy of strain imaging for the localization of the APs in Wolff-Parkinson-White syndrome.
  
  
  METHODS
  We prospectively studied 25 patients (mean age = 32 ± 17 years, 58.3% men) with evidence of pre-excitation on electrocardiography (ECG). Electromechanical interval was defined as the time difference between the onset of delta wave and the onset of regional myocardial contraction. Time differences between the onset of delta wave (δ) and the onset of regional myocardial contraction (δ-So), peak systolic motion (δ-Sm), regional strain (δ-ε), peak strain (δ-εp), and peak strain rate (δ-SRp) were measured.
  
  
  RESULTS
  There was a significant difference between time to onset of delta wave to onset of peak systolic motion (mean ± SD) in the AP location (A) and normal segments (B) versus that in the normal volunteers (C) [A: (57.08 ± 23.88 msec) vs. B: (75.20 ± 14.75) vs. C: (72.9 0 ± 11.16); p value (A vs. B) = 0.004 and p value (A vs. C) = 0.18] and [A: (49.17 ± 35.79) vs. B: (67.60 ± 14.51) vs. C: (67.40 ± 6.06 msec); p value (A vs. B) < 0.001 and p value (A vs. C) = 0.12, respectively].
  
  
  CONCLUSIONS
  Our study showed that strain imaging parameters [(δ-So) and (δ-Strain)] are superior to the ECG in the localization of the APs (84% vs. 76%).
authors: Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors: Maryam
authors: M
authors: Esmaeilzadeh
authors: Mohammad Taghi Salehi
authors: MT
authors: Omran
authors: Majid
authors: M
authors: Maleki
authors: Majid
authors: M
authors: Haghjoo
authors: Feridoun
authors: F
authors: Noohi
authors: Zahra Ojaghi
authors: ZO
authors: Haghighi
authors: Anita
authors: A
authors: Sadeghpour
authors: Paridokht Nakhostin
authors: PN
authors: Davari
authors: Hooman Bakhshandeh
authors: HB
authors: Abkenar
keywords: Ablation; Accessory atrioventricular bundle; Diagnosis; Wolff-Parkinson-White syndrome
references: J Am Soc Echocardiogr. 1999 Jan;12(1):32-40
references: 9882776
references: J Am Coll Cardiol. 1995 Mar 1;25(3):717-24
references: 7860919
references: Circulation. 2006 Jun 6;113(22):e835-9
references: 16754805
references: Circulation. 1976 Feb;53(2):249-57
references: 1245032
references: Circulation. 1992 May;85(5):1666-74
references: 1572025
references: Am Heart J. 1998 Jan;135(1):99-106
references: 9453528
references: Cardiology. 1999;92(3):189-95
references: 10754350
references: Am J Cardiol. 1996 Jan 1;77(1):64-71
references: 8540460
references: Circulation. 1992 Jan;85(1):130-42
references: 1728442
references: Pacing Clin Electrophysiol. 1994 Nov;17(11 Pt 2):2156-62
references: 7845835
references: Chest. 1977 Apr;71(4):463-9
references: 852320
references: J Am Coll Cardiol. 1999 Mar;33(3):782-7
references: 10080481
references: Pacing Clin Electrophysiol. 1994 Dec;17(12 Pt 1):2315-35
references: 7885941
references: Indian Pacing Electrophysiol J. 2005 Jul 01;5(3):155-9
references: 16943864
references: Circulation. 1997 Oct 7;96(7):2430-7
references: 9337220
references: J Am Soc Echocardiogr. 1994 Sep-Oct;7(5):441-58
references: 7986541
references: Am J Cardiol. 2005 Mar 1;95(5):660-4
references: 15721115
references: G Ital Cardiol. 1995 May;25(5):639-47
references: 7642068