The Effect of Accessory Pathway Location on Cardiac Function in Adult Patients with Wolff–Parkinson–White Syndrome

Author:

Zhang Ying12,Xin Mei3,Liu Tongbao1,Song Shangming1,Wang Wenxin4,Li Jun4,Xu Bo4,Hou Xiaoyang1ORCID,Dong Bo124

Affiliation:

1. Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250012, Shandong, China

2. Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250012, Shandong, China

3. Department of Cardiology, The Fifth People’s Hospital of Jinan, Jinan 250022, Shandong, China

4. Department of Intensive Care Unit, Qinghai Red Cross Hospital, Xining 810000, Qinghai, China

Abstract

Introduction. The relationship between ventricular pre-excitation and left ventricular dysfunction has been described in the absence of sustained supraventricular tachycardia in a series of case reports. However, there have been no systematic studies about the effect of ventricular pre-excitation on cardiac function in adult patients with different accessory pathway locations. Methods and Results. Patients were divided into four groups based on the type and location of their accessory pathway: septal, right free wall, left free wall, and concealed. N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, electrocardiogram recordings, electrophysiological properties, and transthoracic echocardiographic data (septal-to-posterior wall motion delay (SPWMD) and interventricular mechanical delay (IVMD) indicating intraventricular and interventricular dyssynchrony) were compared before and after successful ablation. Before radiofrequency catheter ablation, left ventricular ejection fraction (LVEF) was significantly lower in patients with septal and right free wall accessory pathways. Within three months after radiofrequency catheter ablation, NT-proBNP levels decreased, left ventricular function improved, and intraventricular left ventricular dyssynchrony disappeared. There was a negative correlation between initial LVEF with initial QRS duration and initial SPWMD. Notably, SPWMD had a stronger correlation with LVEF than initial QRS duration. Conclusions. Anterograde conduction with a septal or right free wall accessory pathway may cause left ventricular dyssynchrony and impair left ventricular function. Intraventricular left ventricular dyssynchrony seems to be responsible for the pathogenesis of left ventricular dysfunction. Radiofrequency catheter ablation results in decreased NT-proBNP levels, normalized QRS duration, mechanical resynchronization, and improved left ventricular function.

Funder

Program of Taishan Scholars Programme

Publisher

Hindawi Limited

Subject

Cardiology and Cardiovascular Medicine

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