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Ishizu T, Seo Y, Igarashi M, Sekiguchi Y, Machino-Ohtsuka T, Ogawa K, Kuroki K, Yamamoto M, Nogami A, Kawakami Y, Aonuma K. Noninvasive Localization of Accessory Pathways in Wolff-Parkinson-White Syndrome by Three-Dimensional Speckle Tracking Echocardiography. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.004532. [PMID: 27307551 DOI: 10.1161/circimaging.116.004532] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/05/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND We have developed a noninvasive isochrone activation imaging (AI) system with 3-dimensional (3D) speckle tracking echocardiography (STE), which allows visualization of the wavefront image of mechanical propagation of the accessory pathway (ACP) in Wolff-Parkinson-White syndrome. METHODS AND RESULTS Patients with manifest Wolff-Parkinson-White syndrome were imaged in 3D-STE AI mode, which quantified the time from QRS onset to regional endocardial deformation. In 2 patients with left- and right-side ACP, we confirmed that intraoperative contact endocardial electric mapping and the 3D-STE AI system showed comparable images pre- and postablation. In normal heart assessment by 3D-echo AI, the earliest activation sites were found at the attachment of the papillary muscles in the left ventricle and midseptum in the right ventricle, and none showed earliest activation at the peri-atrioventricular valve annuli. An analyzer who was unaware of the clinical information assessed 39 ACP locations in 38 Wolff-Parkinson-White syndrome patients using 3D-STE. All showed abnormal perimitral or tricuspid annular activations, and the location of 34 ACP (87%) showed agreement with the successful ablation sites within a 2-o'clock range. Especially for left free wall ACP, 17/18 (94%) showed consistency with the ablation site within a 2 o'clock range. Among 15 ACP at the ventricular septum, 9 (60%) showed early local activation in both right and left sides of the septum. CONCLUSIONS Isochrone AI with 3D-STE may be a promising noninvasive imaging tool to assess cardiac synchronized activation in normal hearts and detect abnormal breakthrough of mechanical activation from both atrioventricular annuli in Wolff-Parkinson-White syndrome.
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Affiliation(s)
- Tomoko Ishizu
- From the Department of Clinical Laboratory Medicine, Faculty of Medicine (T.I., Y.K.) and Cardiovascular Division, Faculty of Medicine (Y.Seo, M.I., Y.Sekiguchi, K.O., K.K., T.M.-O., M.Y., A.N., K.A.), University of Tsukuba, Japan.
| | - Yoshihiro Seo
- From the Department of Clinical Laboratory Medicine, Faculty of Medicine (T.I., Y.K.) and Cardiovascular Division, Faculty of Medicine (Y.Seo, M.I., Y.Sekiguchi, K.O., K.K., T.M.-O., M.Y., A.N., K.A.), University of Tsukuba, Japan
| | - Miyako Igarashi
- From the Department of Clinical Laboratory Medicine, Faculty of Medicine (T.I., Y.K.) and Cardiovascular Division, Faculty of Medicine (Y.Seo, M.I., Y.Sekiguchi, K.O., K.K., T.M.-O., M.Y., A.N., K.A.), University of Tsukuba, Japan
| | - Yukio Sekiguchi
- From the Department of Clinical Laboratory Medicine, Faculty of Medicine (T.I., Y.K.) and Cardiovascular Division, Faculty of Medicine (Y.Seo, M.I., Y.Sekiguchi, K.O., K.K., T.M.-O., M.Y., A.N., K.A.), University of Tsukuba, Japan
| | - Tomoko Machino-Ohtsuka
- From the Department of Clinical Laboratory Medicine, Faculty of Medicine (T.I., Y.K.) and Cardiovascular Division, Faculty of Medicine (Y.Seo, M.I., Y.Sekiguchi, K.O., K.K., T.M.-O., M.Y., A.N., K.A.), University of Tsukuba, Japan
| | - Kojiro Ogawa
- From the Department of Clinical Laboratory Medicine, Faculty of Medicine (T.I., Y.K.) and Cardiovascular Division, Faculty of Medicine (Y.Seo, M.I., Y.Sekiguchi, K.O., K.K., T.M.-O., M.Y., A.N., K.A.), University of Tsukuba, Japan
| | - Kenji Kuroki
- From the Department of Clinical Laboratory Medicine, Faculty of Medicine (T.I., Y.K.) and Cardiovascular Division, Faculty of Medicine (Y.Seo, M.I., Y.Sekiguchi, K.O., K.K., T.M.-O., M.Y., A.N., K.A.), University of Tsukuba, Japan
| | - Masahiro Yamamoto
- From the Department of Clinical Laboratory Medicine, Faculty of Medicine (T.I., Y.K.) and Cardiovascular Division, Faculty of Medicine (Y.Seo, M.I., Y.Sekiguchi, K.O., K.K., T.M.-O., M.Y., A.N., K.A.), University of Tsukuba, Japan
| | - Akihiko Nogami
- From the Department of Clinical Laboratory Medicine, Faculty of Medicine (T.I., Y.K.) and Cardiovascular Division, Faculty of Medicine (Y.Seo, M.I., Y.Sekiguchi, K.O., K.K., T.M.-O., M.Y., A.N., K.A.), University of Tsukuba, Japan
| | - Yasushi Kawakami
- From the Department of Clinical Laboratory Medicine, Faculty of Medicine (T.I., Y.K.) and Cardiovascular Division, Faculty of Medicine (Y.Seo, M.I., Y.Sekiguchi, K.O., K.K., T.M.-O., M.Y., A.N., K.A.), University of Tsukuba, Japan
| | - Kazutaka Aonuma
- From the Department of Clinical Laboratory Medicine, Faculty of Medicine (T.I., Y.K.) and Cardiovascular Division, Faculty of Medicine (Y.Seo, M.I., Y.Sekiguchi, K.O., K.K., T.M.-O., M.Y., A.N., K.A.), University of Tsukuba, Japan
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De Boeck BWL, Teske AJ, Leenders GE, Mohamed Hoesein FAA, Loh P, van Driel VJ, Doevendans PA, Prinzen FW, Cramer MJ. Detection and quantification by deformation imaging of the functional impact of septal compared to free wall preexcitation in the Wolff-Parkinson-White syndrome. Am J Cardiol 2010; 106:539-546.e2. [PMID: 20691313 DOI: 10.1016/j.amjcard.2010.03.066] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 03/30/2010] [Accepted: 03/30/2010] [Indexed: 11/30/2022]
Abstract
Pacing experiments in healthy animal hearts have suggested a larger detrimental effect of septal compared to free wall preexcitation. We investigated the intrinsic relation among the site of electrical preexcitation, mechanical dyssynchrony, and dysfunction in human patients. In 33 patients with Wolff-Parkinson-White (WPW) syndrome and 18 controls, regional myocardial deformation was assessed by speckle tracking mapping (ST-Map) to assess the preexcitation site, shortening sequences and dyssynchrony, and the extent of local and global ejecting shortening. The ST-Map data in patients with accessory atrioventricular pathways correctly diagnosed as located in the interventricular septum (IVS) (n = 11) or left ventricular free wall (LFW) (n = 12) were compared to the corresponding control values. A local ejecting shortening of <2 SD of the control values identified hypokinetic segments. The localization of the atrioventricular pathways by ST-Map matched with the invasive electrophysiology findings in 23 of 33 patients and was one segment different in 5 of 33 patients. In both WPW-IVS and WPW-LFW, local ejecting shortening was impaired at the preexcitation site (p <0.01). However, at similar electrical and mechanical dyssynchrony, WPW-IVS had more extensive hypokinesia than did WPW-LFW (3.6 +/- 0.9 vs 1.8 +/- 1.3 segments, p <0.01). Compared to controls, the left ventricular function was significantly reduced only in WPW-IVS (global ejecting shortening 17 +/- 2% vs 19 +/- 2%, p = 0.01; ejection fraction 55 +/- 5% vs 59 +/- 3%, p = 0.02). In conclusion, preexcitation is associated with local hypokinesia, which at comparable preexcitation is more extensive in WPW-IVS than in WPW-LFW and could adversely affect ventricular function. ST-Map might have a future role in detecting and guiding treatment of septal pathways with significant mechanical effects.
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