Application of tissue Doppler imaging technique in evaluating early ventricular contraction associated with accessory atrioventricular pathways in Wolff-Parkinson-White syndrome.

To examine the feasibility of a tissue Doppler imaging (TDI) technique for evaluating the early contraction sites in Wolff-Parkinson-White (WPW) syndrome, we analyzed the time-sequential changes in ventricular wall motion in WPW syndrome by TDI. Fifty patients with WPW syndrome were examined by the TDI system in which the high-speed scanning technique allowed for a frame rate up to 38 frames/sec. Among 42 patients in whom the acceptable images were obtained by TDI, the early contraction, which was represented by a red or blue spot appearing on the subendocardial side at the time of the delta wave in the electrocardiogram, was demonstrated in 25 of 29 patients with left-sided accessory pathways. However, in 13 patients with right-sided pathways, the early contraction sites could be identified in only five patients. The TDI-determined early contraction sites were well coincided with the sites of the accessory pathways determined by the electrophysiologic examination (p < 0.01). After the successful radiofrequency catheter ablation, early contraction sites were found to disappear by TDI in all patients. These results demonstrate the feasibility of the TDI technique to evaluate the early ventricular contraction associated with the atrioventricular accessory pathways. We suggest that the TDI system is helpful to localize the accessory pathways and to evaluate the results after radiofrequency ablation, although further studies are necessary to demonstrate the advantage of TDI over conventional echocardiography and electrophysiologic study in the evaluation of the accessory pathways in WPW syndrome.