Altered myocardial characteristics of the preexcited segment in Wolff-Parkinson-White syndrome: A pilot study with cardiac magnetic resonance imaging

• Published in: PloS one 2018-06, Vol.13 (6), p.e0198218-e0198218
• Main Authors: Lee, Hye-Jeong, Uhm, Jae-Sun, Hong, Yoo Jin, Hur, Jin, Choi, Byoung Wook, Joung, Boyoung, Kim, Young Jin
• Format: Article
• Language: English
• Subjects: Ablation; Adult; Aged; Akinesia; Biology and Life Sciences; Cardiology; Cardiovascular disease; Care and treatment; Contrast Media; Coronary vessels; Diagnosis; Echocardiography; Electrocardiography; Electrophysiology; Female; Fibrosis; Gadolinium; Heart; Heart Conduction System - physiopathology; Heart diseases; Heart failure; Hospitals; Humans; Magnetic resonance; Magnetic resonance imaging; Magnetic Resonance Imaging, Cine; Male; Medical records; Medicine; Medicine and Health Sciences; Middle Aged; Morphology; Myocardium; Myocardium - pathology; NMR; Nuclear magnetic resonance; Patients; Physical characteristics; Physical Sciences; Pilot Projects; Prospective Studies; Radio frequency; Radiofrequency Ablation; Radiology; Research and Analysis Methods; Resonance; Septum; Thinning; Ventricle; Ventricular Dysfunction, Left - physiopathology; Wolff-Parkinson-White syndrome; Wolff-Parkinson-White Syndrome - diagnostic imaging; Wolff-Parkinson-White Syndrome - pathology; Wolff-Parkinson-White Syndrome - physiopathology; Wolff-Parkinson-White Syndrome - surgery
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0198218

The preexcited myocardium of Wolff-Parkinson-White (WPW) syndrome would have different characteristics from normal myocardium and these findings might be related to persistent left ventricular systolic dysfunction. We evaluated myocardial tissue characteristics at the preexcited segment in adult WPW syndrome patients and their implicated findings. For this prospective study, we enrolled 22 adult WPW syndrome patients (16 male, mean 45.4 ± 17.8 years) with echocardiographic findings of regional wall motion abnormality in our electrophysiology clinic. Of these patients, 14 underwent radiofrequency ablation before cardiac magnetic resonance imaging. All patients underwent cardiac magnetic resonance imaging including cine and late gadolinium enhancement. The ventricular morphology, function and myocardial characteristics of the preexcited segment were analyzed. A relatively high prevalence of late gadolinium enhancement (9/22, 40.9%) was observed exclusively at the basal septum. The septal accessory pathway was significantly more prevalent in patients with late gadolinium enhancement (P = 0.011). The prevalences of regional myocardial wall thinning and regional akinesia were significantly higher (P = 0.001 for both) and left ventricular function was significantly decreased in patients with late gadolinium enhancement (P < 0.001). In addition, there were no significant relationships between radiofrequency ablation and regional akinesia (P > 0.999), regional myocardial wall thinning (P > 0.999), late gadolinium enhancement (P = 0.662) and low ejection fraction (P > 0.999). Myocardial fibrosis was observed at the preexcited myocardium of adult WPW syndrome patients with septal accessory pathway, which could accompany regional akinesia and regional myocardial wall thinning and might be related to persistent left ventricular systolic dysfunction even after radiofrequency ablation.