Detection of the earliest ventricular contraction site in patients with Wolff-Parkinson-White syndrome using two-dimensional guided M-mode tissue Doppler echocardiography

Objective: The purpose of this study was to examine the feasibility of M-mo de 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 leve ls in 13 WPW patients. Time intervals were measured from the onset of the d elta wave or the R wave to the beginning of the ventricular systolic motion . The earliest contraction site was defined as the site demonstrating the s hortest time interval, and compared with the earliest activated site determ ined by body surface mapping and the successful ablation site. Results: In 6 patients with a left-sided pathway, tissue Doppler localization was ident ical to the ablation site. In 3 with a left-sided pathway and 3 with a righ t-sided pathway, localization was judged as an adjacent region of the ablat ion site. In 1 patient with a right lateral pathway, the pathway location w as misdiagnosed. The tissue Doppler diagnosis for the left-sided pathways c orrelated well with the ablation site, in contrast to the right-sided pathw ays (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 earlie st contraction sites and seems helpful in localizing the left-sided accesso ry pathways, but is of limited use for right-sided pathways. Copyright (C) 2000 S.Karger AG, Basel.