Transesophageal echo phase imaging for localizing accessory pathways during adenosine-induced preexcitation in patients with the Wolff-Parkinson-White syndrome
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-dimension...
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| Main Authors: | , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
1 January 1996
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| In: |
The American journal of cardiology
Year: 1996, Volume: 77, Issue: 1, Pages: 64-71 |
| ISSN: | 1879-1913 |
| DOI: | 10.1016/S0002-9149(97)89136-9 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/S0002-9149(97)89136-9 Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S0002914997891369 
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| Author Notes: | Helmut F. Kuecherer, Gaspar-da-Silva Kleber, Juraj Melichercik, Rudolph Schützendübel, Thorsten Beyer, Johannes Brachmann, Wolfgang Kübler |
| Summary: | 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. |
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| Item Description: | Elektronische Reproduktion der Druck-Ausgabe 30. November 1999 Gesehen am 15.05.2024 |
| Physical Description: | Online Resource |
| ISSN: | 1879-1913 |
| DOI: | 10.1016/S0002-9149(97)89136-9 |