Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Division of Cardiology, Cardiovascular Hospital, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
PLoS One. 2018 Jun 1;13(6):e0198218. doi: 10.1371/journal.pone.0198218. eCollection 2018.
The preexcited myocardium of Wolff-Parkinson-White (WPW) syndrome would have different characteristics from normal myocardium and these findings might be related to persistent left ventricular systolic dysfunction. We evaluated myocardial tissue characteristics at the preexcited segment in adult WPW syndrome patients and their implicated findings.
For this prospective study, we enrolled 22 adult WPW syndrome patients (16 male, mean 45.4 ± 17.8 years) with echocardiographic findings of regional wall motion abnormality in our electrophysiology clinic. Of these patients, 14 underwent radiofrequency ablation before cardiac magnetic resonance imaging. All patients underwent cardiac magnetic resonance imaging including cine and late gadolinium enhancement. The ventricular morphology, function and myocardial characteristics of the preexcited segment were analyzed.
A relatively high prevalence of late gadolinium enhancement (9/22, 40.9%) was observed exclusively at the basal septum. The septal accessory pathway was significantly more prevalent in patients with late gadolinium enhancement (P = 0.011). The prevalences of regional myocardial wall thinning and regional akinesia were significantly higher (P = 0.001 for both) and left ventricular function was significantly decreased in patients with late gadolinium enhancement (P < 0.001). In addition, there were no significant relationships between radiofrequency ablation and regional akinesia (P > 0.999), regional myocardial wall thinning (P > 0.999), late gadolinium enhancement (P = 0.662) and low ejection fraction (P > 0.999).
Myocardial fibrosis was observed at the preexcited myocardium of adult WPW syndrome patients with septal accessory pathway, which could accompany regional akinesia and regional myocardial wall thinning and might be related to persistent left ventricular systolic dysfunction even after radiofrequency ablation.
沃尔夫-帕金森-怀特（WPW）综合征的预激心肌与正常心肌具有不同的特征，这些发现可能与持续的左心室收缩功能障碍有关。我们评估了成人 WPW 综合征患者预激节段的心肌组织特征及其相关发现。
在我们的电生理诊所，这项前瞻性研究纳入了 22 名具有区域性壁运动异常超声心动图表现的成年 WPW 综合征患者（16 名男性，平均年龄 45.4±17.8 岁）。其中 14 名患者在心脏磁共振成像（CMR）前接受了射频消融术。所有患者均行心脏 CMR 检查，包括电影和钆延迟增强。分析预激节段的心室形态、功能和心肌特征。
在基底间隔部观察到相对较高的钆延迟增强（9/22，40.9%）发生率。伴有钆延迟增强的患者中，间隔旁路更常见（P=0.011）。区域性心肌壁变薄和区域性无运动的发生率显著升高（两者均 P=0.001），伴有钆延迟增强的患者左心室功能明显降低（P＜0.001）。此外，射频消融术与区域性无运动（P＞0.999）、区域性心肌壁变薄（P＞0.999）、钆延迟增强（P=0.662）和低射血分数（P＞0.999）之间均无显著关系。
在伴有间隔旁路的成年 WPW 综合征患者的预激心肌中观察到心肌纤维化，可能伴有区域性无运动和区域性心肌壁变薄，并可能与持续的左心室收缩功能障碍有关，即使在射频消融术后也是如此。
