title: Dyspnoea related to pre-excitation during sinus rhythm as a new indication for catheter ablation.
abstract: BACKGROUND
  Patients with pre-excitation without arrhythmic symptoms are diagnosed as Wolff-Parkinson-White (WPW) pattern.
  
  
  OBJECTIVE
  To evaluate the efficacy of radiofrequency ablation (RFA) in patients with a WPW pattern and reported dyspnoea.
  
  
  METHODS
  Five patients (four adults and one adolescent, all female, age 33 ± 15 years) with a WPW pattern were referred due to dyspnoea and exercise intolerance. None had a history of paroxysmal syncope, pre-syncope, dizziness or palpitation. Before and after RFA, additional tests were used to exclude organic diseases of the pulmonary vessels, heart and lung, as well as bronchial hyperreactivity and metabolic diseases. Cardiopulmonary exercise test (CPET), echocardiography, time of forced expiration, baseline dyspnoea index (BDI), and transition dyspnoea index (TDI) were included into an objective evaluation of breath pattern.
  
  
  RESULTS
  In all investigated patients, no arrhythmia was inducible during the electrophysiology study. The time of forced expiration increased immediately after RFA from 15.8 ± 2.9 to 29.2 ± 4.4 s (p < 0.001). The BDI score before RFA was 6.7 ± 1.9 and the TDI score after RFA showed a significant improvement: 8.0 ± 1.2 (p < 0.05). CPET revealed significant improvement in cardiopulmonary capacity after RFA in all cases: peak oxygen consumption [mL/kg/min]: 31.1 ± 7 vs. 42.6 ± 9.6 (p = 0.014); peak exercise minute ventilation [L/min]: 60.0 ± 19.9 vs. 82.0 ± 27 (p = 0.006); peak exercise tidal volume [L]: 1.56 ± 0.25 vs. 2.04 ± 0.24 (p = 0.002); ratio dead space/tidal volume at the end of exercise: 28 ± 2.6 vs. 25 ± 2.3 (p = 0.005).
  
  
  CONCLUSIONS
  Dyspnoea during sinus rhythm in women with pre-excitation may be considered to be an evaluation criterion before RFA.
authors: Sebastian M
authors: SM
authors: Stec
authors: Medical University of Warsaw The Medical Centre of Postgraduate Education. s.szmit@gmail.com.
authors: Sebastian
authors: S
authors: Szmit
authors: Lesław
authors: L
authors: Szydłowski
authors: Konrad
authors: K
authors: Dudek
authors: Magdalena
authors: M
authors: Zagrodzka
authors: Marian
authors: M
authors: Futyma
authors: Grzegorz
authors: G
authors: Opolski
authors: Piotr
authors: P
authors: Kułakowski
mesh_terms: D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004417:Dyspnea / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D011044:Poland; D014927:Wolff-Parkinson-White Syndrome / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*