Cardiac memory in patients with Wolff-Parkinson-White syndrome - Noninvasive imaging of activation and repolarization before and after catheter ablation

Article

关键词: TRANSIENT OUTWARD CURRENT;    ACCESSORY PATHWAYS;    HUMAN HEART;    T-WAVE;    RECONSTRUCTION;    LOCALIZATION;    ELECTROGRAMS;    DISPERSION;    ECGI;   

DOI  :  10.1161/CIRCULATIONAHA.108.781658

来源: SCIE

【 摘 要 】

Background - Cardiac memory refers to a change in ventricular repolarization induced by and persisting for minutes to months after cessation of a period of altered ventricular activation (eg, resulting from pacing or preexcitation in patients with Wolff-Parkinson-White syndrome). ECG imaging (ECGI) is a novel imaging modality for noninvasive electroanatomic mapping of epicardial activation and repolarization. Methods and Results - Fourteen pediatric patients with Wolff-Parkinson-White syndrome and no other congenital disease, were imaged with ECGI a day before and 45 minutes, 1 week, and 1 month after successful catheter ablation. ECGI determined that preexcitation sites were consistent with sites of successful ablation in all cases to within a 1-hour arc of each atrioventricular annulus. In the preexcited rhythm, activation-recovery interval (ARI) was the longest (349 +/- 6 ms) in the area of preexcitation leading to high average base-to-apex ARI dispersion of 95 +/- 9 ms (normal is approximate to 40 ms). The ARI dispersion remained the same 45 minutes after ablation, although the activation sequence was restored to normal. ARI dispersion was still high (79 +/- 9 ms) 1 week later and returned to normal (45 +/- 6 ms) 1 month after ablation. Conclusions - The study demonstrates that ECGI can noninvasively localize ventricular insertion sites of accessory pathways to guide ablation and evaluate its outcome in pediatric patients with Wolff-Parkinson-White syndrome. Wolff-Parkinson-White is associated with high ARI dispersion in the preexcited rhythm that persists after ablation and gradually returns to normal over a period of 1 month, demonstrating the presence of cardiac memory. The 1-month time course is consistent with transcriptional reprogramming and remodeling of ion channels.

【 授权许可】

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