Detection of the Earliest Ventricular Contraction Site in Patients with Wolff-Parkinson-White Syndrome Using Two-Dimensional Guided M-Mode Tissue Doppler Echocardiography

Abstract

Objective: The purpose of this study was to examine the feasibility of M-mode tissue Doppler imaging for localizing the accessory pathway in patients with Wolff-Parkinson-White (WPW) syndrome. Methods: Two-dimensional guided tissue Doppler M-mode was recorded at the mitral and tricuspid annular levels in 13 WPW patients. Time intervals were measured from the onset of the δ wave or the R wave to the beginning of the ventricular systolic motion. The earliest contraction site was defined as the site demonstrating the shortest time interval, and compared with the earliest activated site determined by body surface mapping and the successful ablation site. Results: In 6 patients with a left-sided pathway, tissue Doppler localization was identical to the ablation site. In 3 with a left-sided pathway and 3 with a right-sided pathway, localization was judged as an adjacent region of the ablation site. In 1 patient with a right lateral pathway, the pathway location was misdiagnosed. The tissue Doppler diagnosis for the left-sided pathways correlated well with the ablation site, in contrast to the right-sided pathways (p = 0.05). Prediction of the accessory pathway localization by tissue Doppler M-mode was equivalent to localization based on body surface mapping. Conclusions: In WPW syndrome, tissue Doppler M-mode can detect the earliest contraction sites and seems helpful in localizing the left-sided accessory pathways, but is of limited use for right-sided pathways.

Visualization of the site of the onset of ventricular depolarization by acceleration mode “Tissue Doppler Imaging” technique

“…The site of initial myocardial activation can be identified by the precise location of the position of the initial velocity [8][9][10]. Acceleration is proportional to the changes of myocardial velocity over time and reported to be more sensitive to the rapid changes of tissue motion than velocity [10].…”

“…Different TDI modalities with M-mode Doppler, velocity mode, acceleration mode and pulsedwave Doppler have used for the detection of the accessory pathways in several studies [6][7][8][9][10][11].…”

“…As has been stated in previous studies, the relatively low frame rate is an important limitation of 2-dimensional acceleration mode TDI [6][7][8][9][10][11]. Sometimes it is difficult to identify the initial abnormal ventricular excited position with a lower frame rate.…”

“…The most frequent applications of TDI are in the evaluation of regional left ventricular (LV) systolic and diastolic functions [2][3][4][5]. Also, TDI offers the promise for the detection of the earliest ventricular contraction site and the time-squential changes in myocardial depolarization [6][7][8][9][10][11]. Several studies reported the ability of the color-coded TDI (velocity or acceleration map) or pulsed-wave TDI modalities to localize the site of the accessory atrioventricular pathways and to evaluate the results of radiofrequency ablation [6][7][8][9][10][11].…”

“…Also, TDI offers the promise for the detection of the earliest ventricular contraction site and the time-squential changes in myocardial depolarization [6][7][8][9][10][11]. Several studies reported the ability of the color-coded TDI (velocity or acceleration map) or pulsed-wave TDI modalities to localize the site of the accessory atrioventricular pathways and to evaluate the results of radiofrequency ablation [6][7][8][9][10][11]. Furthermore, recent studies have suggested a potential role of TDI technique to identify regional wall delay and predict improvement of systolic function or LV reverse remodeling after cardiac resynchronization therapy (CRT) in patients with chronic heart failure and a wide QRS complex [12][13][14][15].…”