Transesophageal echo phase imaging for localizing accessory pathways during adenosine-induced preexcitation in patients with the Wolff-Parkinson-White syndrome

• Verfasst von: Kücherer, Helmut [VerfasserIn]
• Verfasst von: Gaspar Carvalho da Silva, Kleber [VerfasserIn]
• Verfasst von: Melichercik, Juraj [VerfasserIn]
• Verfasst von: Schützendübel, Rudolf [VerfasserIn]
• Verfasst von: Beyer, Thorsten [VerfasserIn]
• Verfasst von: Brachmann, Johannes [VerfasserIn]
• Verfasst von: Kübler, Wolfgang [VerfasserIn]
• Titel: Transesophageal echo phase imaging for localizing accessory pathways during adenosine-induced preexcitation in patients with the Wolff-Parkinson-White syndrome
• Verf.angabe: Helmut F. Kuecherer, Gaspar-da-Silva Kleber, Juraj Melichercik, Rudolph Schützendübel, Thorsten Beyer, Johannes Brachmann, Wolfgang Kübler
• E-Jahr: 1996
• Jahr: 1 January 1996
• Umfang: 8 S.
• Fussnoten: Elektronische Reproduktion der Druck-Ausgabe 30. November 1999 ; Gesehen am 15.05.2024
• Titel Quelle: Enthalten in: The American journal of cardiology
• Ort Quelle: Amsterdam [u.a.] : Elsevier, 1958
• Jahr Quelle: 1996
• Band/Heft Quelle: 77(1996), 1, Seite 64-71
• ISSN Quelle: 1879-1913
• DOI: doi:10.1016/S0002-9149(97)89136-9
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1888722991

Abstract

Transesophageal phase images and precordial electrocardiograph (ECG) were used to localize accessory pathways during adenosine-induced preexcitation in 30 patients (18 men, mean age ± SD 33 ± 14 years) undergoing endocardial mapping for suspected Wolff-Parkinson-White syndrome. Digitized 2-dimensional echocardiographic cine loops were mathematically transformed using a first harmonic Fourier algorithm before and after catheter ablation. Endocardial mapping found single accessory pathways with anterograde conduction in 20 patients, concealed pathways in 7, and atrioventricular reentry circuits in 3 patients. At baseline, precordial ECG correctly localized 8 pathways (40%) with anterograde conduction and predicted 5 adjacent locations (25%), but findings were normal in 7 patients (35%). Phase imaging correctly identified only 3 pathway locations (15%), findings were normal in 15 (75%), and could not be obtained in 2 patients (10%). Adenosine augmented manifest but minimal preexcitation in 9 patients and unmasked latent preexcitation in 7. In 4 patients, preexcitation was already maximal at baseline. During adenosine-augmented preexcitation, ECG correctly identified 13 locations (65%), but still predicted 7 adjacent locations (35%). However, phase imaging correctly identified 15 locations (75%) and predicted only 3 adjacent locations (15%). All midseptal (n = 2) and anteroseptal (n = 2) locations were correctly identified by phase imaging, but none by ECG. On follow-up studies in 16 patients, successful catheter ablation (n = 13) was equally well confirmed by ECG and phase imaging. Therefore, transesophageal echocardiographic phase imaging during adenosine-induced preexcitation is a readily available and safe procedure that appears clinically most useful for identifying septal pathways.