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.
Highlights
Wolff–Parkinson–White (WPW) is a cardiac pre-excitation syndrome caused by an accessory pathway (AP) that bypasses the atrioventricular node and is associated with supraventricular tachycardia [1]
There have been no systematic studies on the effect of ventricular pre-excitation with different accessory pathway locations on cardiac function, especially in adult patients exposed to the accessory pathway for an extended period
Our results suggest that right-sided accessory pathways, especially septal accessory pathways, may impair left ventricular (LV) function, manifested as elevated BNP levels and decreased Left ventricular ejection fraction (LVEF)
Summary
Wolff–Parkinson–White (WPW) is a cardiac pre-excitation syndrome caused by an accessory pathway (AP) that bypasses the atrioventricular node and is associated with supraventricular tachycardia [1]. Incessant or recurrent AP-mediated supraventricular tachycardia (SVT) can cause dilated cardiomyopathy [2, 3]. It has been reported that some patients with overt ventricular pre-excitation, either children or adults, develop left ventricular dysfunction and dilated cardiomyopathy in the absence of documented SVT [4,5,6]. Suppression or elimination of pre-excitation can reverse the remodeling of ventricular mechanics. There have been no systematic studies on the effect of ventricular pre-excitation with different accessory pathway locations on cardiac function, especially in adult patients exposed to the accessory pathway for an extended period
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