BODY-SURFACE DISTRIBUTION OF ABNORMALLY LOW QRST AREAS IN PATIENTS WITH WOLFF-PARKINSON-WHITE SYNDROME - EVIDENCE FOR CONTINUATION OF REPOLARIZATION ABNORMALITIES BEFORE AND AFTER CATHETER ABLATION

Citation
M. Hirai et al., BODY-SURFACE DISTRIBUTION OF ABNORMALLY LOW QRST AREAS IN PATIENTS WITH WOLFF-PARKINSON-WHITE SYNDROME - EVIDENCE FOR CONTINUATION OF REPOLARIZATION ABNORMALITIES BEFORE AND AFTER CATHETER ABLATION, Circulation, 88(6), 1993, pp. 2674-2684
Citations number
32
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiac & Cardiovascular System",Hematology
Journal title
Circulation → ACNP
ISSN journal
0009-7322
Volume
88
Issue
6
Year of publication
1993
Pages
2674 - 2684
Database
ISI
SICI code
0009-7322(1993)88:6<2674:BDOALQ>2.0.ZU;2-V
Abstract
Background. Whether the Wolff-Parkinson-White syndrome (WPW) is associ ated with repolarization abnormalities is controversial. The QRST isoi ntegral map (I-map) is theoretically independent of the activation seq uence and dependent on repolarization properties. There have been no r eports concerning the effects of radiofrequency (RF) catheter ablation of accessory pathway (AP) on repolarization properties analyzed by I- mapping. Methods and Results. I-maps were constructed from data record ed in 38 patients with WPW to investigate repolarization properties an d their body surface distribution in a physiological state, without ph armacological influences, and in 13 ablated patients to elucidate the effects of RF ablation on repolarization properties. Patients were div ided into three groups: group A, 15 patients with type A WPW (left-sid ed AP); group B, 10 patients with type B (right-sided AP); and group C , 13 patients who were successfully ablated, Group C consisted of thre e subgroups: subgroup C-A, 7 patients with type A WPW; subgroup C-B, 3 patients with type B WPW; and subgroup C-C, 3 patients with concealed WPW. Controls consisted of 608 normals. Although I-maps of WPW were h ighly (r=.87) correlated with the mean normal I-map, the location of t he minimum in groups A and B differed significantly from that in norma ls. The minimum was located over the upper right anterior chest in nor mal subjects, over the back in 82% of 22 patients with type A WPW incl uding ablated patients (groups A+C-A), and over the mid to lower right anterior chest in 62% of 13 patients with type B WPW including ablate d patients (groups B+C-B). Groups A+C-A and B+C-B had an abnormally lo w QRST area (''-2SD area'') over the back and right anterior chest, re spectively. The abnormally located minimum and the ''-2SD area'' were present in 7 of 10 ablated patients with manifest WPW (groups C-A+C-B) . After RF ablation, the distribution of the minimum, initially abnorm al; became normal over a period of days or weeks, and the ''-2SD area' ' disappeared over 1 week in all 7 patients. Correlation coefficients between I-maps and the mean normal I-map increased after RP ablation. Conclusions. (1) WPW is often associated with abnormalities in repolar ization properties. (2) Repolarization abnormalities were located over the back in type A WPW and over the right mid to lower chest in type B WPW. (3) The abnormalities remain immediately after RF ablation and gradually normalize. These findings support the concept that ST-T abno rmalities in 12-lead ECGs following RP ablation are attributable to '' cardiac memory.''