Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea.
J Cardiovasc Electrophysiol. 2010 Mar;21(3):290-5. doi: 10.1111/j.1540-8167.2009.01612.x. Epub 2009 Oct 5.
Echocardiographic studies have shown that some patients with Wolff-Parkinson-White (WPW) syndrome have myocardial dyskinesia in the segments precociously activated by an accessory pathway (AP). The aim of the present study was to determine the extent to which the AP contributes to global left ventricular (LV) dysfunction.
Electrophysiological and echocardiographic data from 62 children with WPW (age at diagnosis = 5.9 +/- 4.2 years) were retrospectively analyzed.
The left ventricular ejection fraction (LVEF) of patients with septal APs (53 +/- 11%) was significantly lower than that of patients with right (62 +/- 5%) or left (61 +/- 4%) APs (P = 0.001). Compared to patients with normal septal motion (n = 56), patients with septal dyskinesia (n = 6) had a reduced LVEF (61 +/- 4% and 42 +/- 5%, respectively) and an increased LV end diastolic dimension (P < 0.001 for both comparisons). Multivariate analysis identified septal dyskinesia as the only significant risk factor for reduced LVEF. All 6 patients with septal dyskinesia had right septal APs, and a preexcited QRS duration that was longer than that of patients with normal septal motion (140 +/- 18 ms and 113 +/- 32 ms, respectively; P = 0.045). After RFA there were improvements in both intraventricular dyssynchrony (septal-to-posterior wall motion delay, from 154 +/- 91 ms to 33 +/- 17 ms) and interventricular septal thinning (from 3.0 +/- 0.5 mm to 5.3 +/- 2.6 mm), and a significant increase in LVEF (from 42 +/- 5% to 67 +/- 8%; P = 0.001).
The dyskinetic segment activated by a right septal AP in WPW syndrome may lead to ventricular dilation and dysfunction. RFA produced mechanical resynchronization, reverse remodeling, and improvements in LV function.
超声心动图研究表明，一些预激综合征（WPW）患者的旁路（AP）提前激活的节段存在心肌运动障碍。本研究旨在确定 AP 对整体左心室（LV）功能障碍的贡献程度。
回顾性分析 62 例 WPW 患儿的电生理和超声心动图数据（诊断时年龄=5.9±4.2 岁）。
间隔旁路（AP）患者的左心室射血分数（LVEF）（53±11%）明显低于右（62±5%）或左（61±4%）AP 患者（P=0.001）。与正常室间隔运动患者（n=56）相比，室间隔运动障碍患者（n=6）的 LVEF 降低（分别为 61±4%和 42±5%），LV 舒张末期内径增加（两次比较 P<0.001）。多变量分析确定室间隔运动障碍是 LVEF 降低的唯一显著危险因素。所有 6 例室间隔运动障碍患者均存在右间隔 AP，且预激 QRS 波时限长于正常室间隔运动患者（分别为 140±18ms 和 113±32ms，P=0.045）。射频消融术后，室内不同步（间隔至后侧壁运动延迟，从 154±91ms 改善至 33±17ms）和室间隔变薄（从 3.0±0.5mm 改善至 5.3±2.6mm）均得到改善，LVEF 显著增加（从 42±5%增加至 67±8%，P=0.001）。
WPW 综合征中右间隔 AP 激活的运动障碍节段可能导致心室扩张和功能障碍。射频消融术产生机械同步化、逆重构和改善 LV 功能。
