Doppler predictors of inducibility of atrial fibrillation in patients with WPW syndrome and atrioventricular re-entrant tachycardia

Abstract

Background — Atrial fibrillation (AF) in patients with Wolff-Parkinson-White syndrome (WPW) may induce complex ventricular arrhythmias resulting in sudden cardiac death. It is essential to find an effective non-invasive diagnostic method allowing to select patients at risk of life-threatening arrhythmias. Our objective was to examine Doppler predictors of AF in patients with WPW and atrioventricular re-entrant tachycardia (AVRT).Material and methods — 65 patients with WPW and AVRT (33 men, mean age 39 ± 11y) were prospectively studied. In all patients TTE was performed with measurements of left ventricle (LV) diameters, volumes and parameters of systolic and diastolic function.TTE was followed by invasive electrophysiology study (EPS) and radiofrequency current ablation of accessory pathway. AF lasting at least 30 s was induced in 29 (44.6%) patients during EPS. Reduction of right upper pulmonary vein (RUPV) systolic velocity (P < 0.005) and systolic to diastolic velocity ratio (P < 0.005) and increase in atrial reversal velocity (P < 0.05) of RUPV flow and difference between duration of RUPV atrial reversal flow and A wave of mitral profile (P < 0.05) were associated with increased risk of AF in patients with WPW syndrome and AVRT. Systolic and atrial reversal velocities were identified as independent predictors of AF in those patients.Conclusions — Systolic and atrial reversal right upper pulmonary vein flow velocities have been shown to be independent predictors of AF inducibility in patients with Wolff-Parkinson-White syndrome and atrioventricular re-entrant tachycardia.