The use of echocardiography in Wolff–Parkinson–White syndrome

Abstract

Endocardial mapping and radiofrequency catheter ablation are well established modalities for the diagnosis and treatment of patients with Wolff-Parkinson-White (WPW) syndrome associated with tachyarrhythmias. However, the electrophysiologic techniques are invasive, require radiation exposure, and lack spatial resolution of cardiac structures. A variety of echocardiographic techniques have been investigated as a non-invasive alternative for accessory pathway localization. Conventional M-mode echocardiography can detect the fine premature wall motion abnormalities associated with WPW syndrome. However, it is unable to identify the exact site of accessory pathway with sufficient accuracy. 2D, 2D-guided M-mode, and 2D phase analysis techniques are limited by image quality and endocardial border definition. Various modalities of tissue Doppler echocardiography significantly increase the accuracy of left-sided accessory pathway localization to 80-90% even in patients with poor acoustic window. However, right-sided pathways remain a diagnostic challenge. Strain echocardiography by speckle tracking has recently been evaluated and appears promising. Different cardiac abnormalities have been detected by echocardiography in WPW patients. Patients with WPW syndrome and tachyarrhythmias have impaired systolic and diastolic function which improves after radiofrequency ablation. Echocardiography is useful in identifying patient with accessory pathway-associated left ventricular dyssynchrony and dysfunction who may benefit from ablation therapy. Transesophageal and intracardiac echocardiography have been used to guide ablation procedure. Ablation-related complications detected by routine echocardiography are infrequent, rarely clinically relevant, and of limited value.

Does Accessory Pathway Significantly Alter Left Ventricular Twist/Torsion? A Study in Wolff‐Parkinson‐White Syndrome by Velocity Vector Imaging

“…VVI is an approach that can be used to analyze myocardial mechanics quantitatively. Angle independency and reproducibility are important advantages of this noninvasive technique which have made it a reliable way in multiple researches . We aimed to measure how much an accessory pathway involves LV twist mechanics in the absence of other concomitant structural heart disease.…”

“…Angle independency and reproducibility are important advantages of this noninvasive technique which have made it a reliable way in multiple researches. [9][10][11][12][13][14][15][16][17][18] We aimed to measure how much an accessory pathway involves LV twist mechanics in the absence of other concomitant structural heart disease. This was of utmost importance as significant abnormalities in torsional deformation consequently lead to remarkable changes in systolic and diastolic function.…”

Assessment of Atrial Fibrillation and Vulnerability in Patients with Wolff-Parkinson-White Syndrome Using Two-Dimensional Speckle Tracking Echocardiography

“…All ECG images were reviewed by a single operator, who was blind to the patients at the time of ECG assessment. ECG parameters were prospectively collected according to current guidelines [26] . The left atrial diameter (LAD), left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), left ventricular mass index in diastole (LVMI), left ventricular mass index in systole (LV mass s index), left atrial maximum volume (LAV max ), left atrial minimal volume (LAV min ), right atrial maximum volume (RAV max ), right atrial minimal volume (RAV min ), and left ventricular mass index (LVMI) of each patient were measured and calculated.…”

Noninvasive Localization of Accessory Pathways in Wolff–Parkinson–White Syndrome by Three-Dimensional Speckle Tracking Echocardiography

“…Therefore, 3D-STE may have appropriate time resolution to identify the approximate location of the abnormal activation sequence in WPW syndrome. Several echocardiographic methods have been reported previously to locate the exact site of the ACP by identifying early deformation, 13 including M-mode, 14 tissue Doppler, 15 2D imaging, 16 and 2D speckle tracking. 17 These methods offer superior time and spatial resolution in comparison to 3D-STE.…”