Objective: The purpose of this study was to examine the feasibility of M-mode tissue Doppler imaging for localizing the accessory pathway in patients with Wolff-Parkinson-White (WPW) syndrome. Methods: Two-dimensional guided tissue Doppler M-mode was recorded at the mitral and tricuspid annular levels in 13 WPW patients. Time intervals were measured from the onset of the δ wave or the R wave to the beginning of the ventricular systolic motion. The earliest contraction site was defined as the site demonstrating the shortest time interval, and compared with the earliest activated site determined by body surface mapping and the successful ablation site. Results: In 6 patients with a left-sided pathway, tissue Doppler localization was identical to the ablation site. In 3 with a left-sided pathway and 3 with a right-sided pathway, localization was judged as an adjacent region of the ablation site. In 1 patient with a right lateral pathway, the pathway location was misdiagnosed. The tissue Doppler diagnosis for the left-sided pathways correlated well with the ablation site, in contrast to the right-sided pathways (p = 0.05). Prediction of the accessory pathway localization by tissue Doppler M-mode was equivalent to localization based on body surface mapping. Conclusions: In WPW syndrome, tissue Doppler M-mode can detect the earliest contraction sites and seems helpful in localizing the left-sided accessory pathways, but is of limited use for right-sided pathways.

Jackman WM, Wang X, Friday KJ, Roman CA, Moulton KP, Beckman KJ, McClelland JH, Twidale N, Hazlitt HA, Prior MI, Margolis PD, Calame JD, Overholt ED, Lazzara R: Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current. N Engl J Med 1991;324:1605–1611.
Calkins H, Langberg J, Sousa J, El-Atassi R, Leon A, Kou W, Kalbfleisch S, Morady F: Radiofrequency catheter ablation of accessory atrioventricular connections in 250 patients: Abbreviated therapeutic approach to Wolff-Parkinson-White syndrome. Circulation 1992;85:1337–1346.
Gallagher JJ, Pritchett ELC, Sealy WC, Kasell J, Wallace AG: The preexcitation syndromes. Prog Cardiovasc Dis 1978;20:285–327.
Iwa T, Kawasuji M, Misaki T, Iwase T, Magara T: Localization and interruption of accessory conduction pathway in the Wolff-Parkinson-White syndrome. J Thorac Cardiovasc Surg 1980;80:271–279.
Willems JL, De Medina EOR, Bernard R, Coumel P, Fisch C, Krikler D, Mazur NA, Meijler FL, Mogensen L, Moret P, Pisa Z, Rautaharju PM, Surawicz B, Watanabe Y, Wellens HJJ: World Health Organization/International Society and Federation of Cardiology Task Force: Criteria for intraventricular conduction disturbances and pre-excitation. J Am Coll Cardiol 1985;5:1261–1275.
Chiang CE, Chen SA, Teo WS, Tsai DS, Wu TJ, Cheng CC, Chiou CW, Tai CT, Lee SH, Chen CY, Wang SP, Chiang BN, Tan A, Chang MS: An accurate stepwise electrocardiographic algorithm for localization of accessory pathways in patients with Wolff-Parkinson-White syndrome from a comprehensive analysis of delta waves and R/S ratio during sinus rhythm. Am J Cardiol 1995;76:40–46.
Iwa T, Magara T: Correlation between localization of accessory conduction pathway and body surface maps in the Wolff-Parkinson-White syndrome. Jpn Circ J 1981;45:1192–1198.
Benson DW, Sterba R, Gallagher JJ, Walston A, Spach MS: Localization of the site of ventricular preexcitation with body surface maps in patients with Wolff-Parkinson-White patients. Circulation 1982;65:1259–1268.
Kamakura S, Shimomura K, Ohe T, Matsuhisa M, Toyoshima H: The role of initial minimum potentials on body surface maps in predicting the site of accessory pathways in patients with Wolff-Parkinson-White syndrome. Circulation 1986;74:89–96.
DeMaria AN, Vera Z, Neumann A, Mason DT: Alterations in ventricular contraction pattern in the Wolff-Parkinson-White syndrome: Detection by echocardiography. Circulation 1976;53:249–257.
Chandra MS, Kerber RE, Brown DD, Funk DC: Echocardiography in Wolff-Parkinson-White syndrome. Circulation 1976;53:943–946.
Francis GS, Theroux P, O’Rourke RA, Hagan AD, Johnson AD: An echocardiographic study of interventricular septal motion in the Wolff-Parkinson-White syndrome. Circulation 1976;54:174–178.
Hishida H, Sotobata I, Koike Y, Okumura M, Mizuno Y: Echocardiographic patterns of ventricular contraction in the Wolff-Parkinson-White syndrome. Circulation 1976;54:567–570.
Ticzon AR, Damato AN, Caracta AR, Russo G, Foster JR, Lau SH: Interventricular septal motion during preexcitation and normal conduction in Wolff-Parkinson-White syndrome: Echocardiographic and electrophysiologic correlation. Am J Cardiol 1976;37:840–847.
Windle JR, Armstrong WF, Feigenbaum H, Miles WM, Prystowsky EN: Determination of the earliest site of ventricular activation in Wolff-Parkinson-White syndrome: Application of digital continuous loop two-dimensional echocardiography. J Am Coll Cardiol 1986;7:1286–1294.
Kuecherer HF, Abbott JA, Botvinick EH, Scheinman ED, O’Connell JW, Scheinman MM, Foster E, Schiller NB: Two-dimensional echocardiographic phase analysis: Its potential for noninvasive localization of accessory pathways in patients with Wolff-Parkinson-White syndrome. Circulation 1992;85:130–142.
Kuecherer HF, Kleber GS, Melichercik J, Schützendübel R, Beyer T, Brachmann J, Kübler W: Transesophageal echo phase imaging for localizing accessory pathways during adenosine-induced preexcitation in patients with the Wolff-Parkinson-White syndrome. Am J Cardiol 1996;77:64–71.
McDicken WN, Sutherland GR, Moran CM, Gordon LN: Colour Doppler velocity imaging of the myocardium. Ultrasound Med Biol 1992;18:651–654.
Miyatake K, Yamagishi M, Tanaka N, Uematsu M, Yamazaki N, Mine Y, Sano A, Hirama M: New method for evaluating left ventricular wall motion by color-coded tissue Doppler imaging: In vitro and in vivo studies. J Am Coll Cardiol 1995;25:717–724.
Nagai H, Takata S, Sakagami S, Furusho H, Takamura M, Yuasa T, Kobayashi K: Two-dimensional guided M-mode color tissue Doppler imaging in artificial preexcitation models. J Am Soc Echocardiogr 1999;12:582–589.
Nakayama K, Miyatake K, Uematsu M, Tanaka N, Kamakura S, Nakatani S, Yamazaki N, Yamagishi M: Application of tissue Doppler imaging technique in evaluating early ventricular contraction associated with accessory atrioventricular pathways in Wolff-Parkinson-White syndrome. Am Heart J 1998;135:99–106.
Drozdz J: Movement of the total heart; in Erbel R, Nesser HJ, Drozdz J (eds): Atlas of Tissue Doppler Echocardiography. Darmstadt, Springer, 1995, pp 45–51.
Ingels N, Daughters G, Stinson E, Alderman E: Evaluation of methods for quantification of left ventricular segmental wall motion in man using myocardial markers as a standard. Circulation 1980;61:966–972.
Sealy WC, Mikat EM: Anatomical problems with identification and interruption of posterior septal Kent bundles. Ann Thorac Surg 1983;36:584–595.
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