Localization of the ventricular preexcitation site in Wolff-Parkinson-White syndrome with Doppler tissue imaging

Purpose: The objective of this study was to evaluate the ability of Doppler tissue imaging (DTI) to localize the ventricular emergence site of accesso ry atrioventricular pathways (Wolff-Parkinson-White syndrome). Methods: Thirty-three patients were studied prospectively by Doppler tissue imaging (128XP and Sequoia 256 echocardiographic systems; Acuson, Mountain View, Calif) before investigation of Wolff-Parkinson-White syndrome and af ter radiofrequency ablation of the accessory pathways. The normal appearanc e of the ventricular contractions was defined in a group of 10 control subj ects. The preexcitation zone was determined as a zone of maximum accelerati on in "DTI acceleration mode" or as a coded contraction zone in "DTI veloci ty mode," at the time of the delta wave or before the onset of the QRS comp lex. Results: The earliest ventricular activation site was correctly localized f or 12 of the 15 left-sided pathways (8 anterior or anterolateral, 2 lateral or posterolateral, 2 inferior). When wall motion abnormalities were detect ed in the left ventricle by DTI, the left-sided localization was confirmed by electrophysiologic exploration. For the right-sided pathways, the locali zation was correct in only 4 of 11 cases (3 posteroseptal and 1 anterolater al). After effective ablation in all patients, the abnormalities correspond ing to the electrophysiologic data disappeared totally in only 11 of 16 pat ients. Conclusion: In the presence of Wolff-Parkinson-White syndrome, DTI localize s contraction abnormalities associated with early activation of a part of t he ventricle. However, the interpretation of the images remains difficult b ecause the normal coding of the contraction of the ventricular walls depend s on the incidence for which they are Investigated. This noninvasive examin ation seems to be an effective tool for localizing the left-sided accessory pathways of the left ventricle, in particular in the anterior, anterolater al, or inferior walls.