Improvement of Echocardiographic M-Mode Detection of Ventricular Precontraction in the Wolff-Parkinson-White Syndrome by Transesophageal Atrial Pacing

• BACKGROUND: The purpose of this study was to evaluate the accuracy of conventional M-mode echocardiography in localizing the site of the accessory pathway in 21 patients with overt Wolff-Parkinson-White (W-P-W) syndrome during sinus rhythm (SR) and during transesophageal atrial stimulation (TAS). METHODS: The invasive electrophysiological study was used as a reference, and the results were compared with the pathway localization obtained through algorithmic interpretation of the 12-lead electrocardiogram during SR. Echocardiographic left parasternal short-axis recordings were performed during SR and TAS (100-120 beats/min). The shortest electromechanical interval measured at six different sites of the atrioventricular valve plane from the onset of the delta wave to the peak of the precontraction defined the pathway localization. RESULTS: Correct localization of the accessory pathway with echocardiography could be attained in 14 patients during SR (14 of 21, or 66%). With the aid of TAS, correct pathway localization was achieved for an additional 2 patients, making a total of 16 patients (76%). During TAS, precontraction was enhanced in 63% of the patients. With the algorithmic electrocardiographic interpretation, the localization of the accessory pathway was correct in 13 of the 21 patients (62%). The differences were not significant. CONCLUSION: M-mode echocardiography is a simple and readily available method for the identification of precontraction. The method is comparable to pathway localization through algorithmic ECG interpretation during SR. Transesophageal left atrial pacing during echocardiography can amplify the precontraction and thereby facilitate the interpretation of the wall motions.

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