Document Detail


Cardiac memory in patients with Wolff-Parkinson-White syndrome: noninvasive imaging of activation and repolarization before and after catheter ablation.
MedLine Citation:
PMID:  18697818     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Cardiac memory refers to a change in ventricular repolarization induced by and persisting for minutes to months after cessation of a period of altered ventricular activation (eg, resulting from pacing or preexcitation in patients with Wolff-Parkinson-White syndrome). ECG imaging (ECGI) is a novel imaging modality for noninvasive electroanatomic mapping of epicardial activation and repolarization.
METHODS AND RESULTS: Fourteen pediatric patients with Wolff-Parkinson-White syndrome and no other congenital disease, were imaged with ECGI a day before and 45 minutes, 1 week, and 1 month after successful catheter ablation. ECGI determined that preexcitation sites were consistent with sites of successful ablation in all cases to within a 1-hour arc of each atrioventricular annulus. In the preexcited rhythm, activation-recovery interval (ARI) was the longest (349+/-6 ms) in the area of preexcitation leading to high average base-to-apex ARI dispersion of 95+/-9 ms (normal is approximately 40 ms). The ARI dispersion remained the same 45 minutes after ablation, although the activation sequence was restored to normal. ARI dispersion was still high (79+/-9 ms) 1 week later and returned to normal (45+/-6 ms) 1 month after ablation.
CONCLUSIONS: The study demonstrates that ECGI can noninvasively localize ventricular insertion sites of accessory pathways to guide ablation and evaluate its outcome in pediatric patients with Wolff-Parkinson-White syndrome. Wolff-Parkinson-White is associated with high ARI dispersion in the preexcited rhythm that persists after ablation and gradually returns to normal over a period of 1 month, demonstrating the presence of cardiac memory. The 1-month time course is consistent with transcriptional reprogramming and remodeling of ion channels.
Authors:
Subham Ghosh; Edward K Rhee; Jennifer N Avari; Pamela K Woodard; Yoram Rudy
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Research Support, N.I.H., Extramural     Date:  2008-08-12
Journal Detail:
Title:  Circulation     Volume:  118     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-08-26     Completed Date:  2008-09-17     Revised Date:  2014-09-12    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  907-15     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Action Potentials / physiology
Adolescent
Algorithms
Catheter Ablation*
Child
Electrocardiography / methods*
Female
Heart Atria
Heart Conduction System / physiology
Heart Ventricles
Humans
Male
Myocardial Contraction / physiology
Predictive Value of Tests
Tomography, X-Ray Computed
Wolff-Parkinson-White Syndrome / diagnosis*,  physiopathology,  surgery*
Grant Support
ID/Acronym/Agency:
R01 HL033343/HL/NHLBI NIH HHS; R01 HL033343-25/HL/NHLBI NIH HHS; R01-HL-49054/HL/NHLBI NIH HHS; R37-HL-33343/HL/NHLBI NIH HHS
Comments/Corrections
Comment In:
Circulation. 2008 Aug 26;118(9):899-900   [PMID:  18725500 ]
Circulation. 2009 Feb 24;119(7):e209; author reply e210   [PMID:  19237667 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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