THE EFFECT OF VENTRICULAR PRE-EXCITATION IN WPW SYNDROME PATIENTS, ON LEFT VENTRICULAR WALL MOTION AND SYSTOLIC FUNCTION, PRE AND POST RADIOFREQUENCY ABLATION OF ACCESSORY PATHWAY

Abstract

Objective: To demonstrate dys-synchrony between interventricular septal motion and left ventricular posterior wall motion in Wolff-Parkinson-White syndrome (WPW) patients resulting in left ventricular (LV) systolic dysfunction and its improvement assessed on post radiofrequency ablation.

Study design: Cross-sectional prospective study

Place and Duration of Study: Department of Cardiac Electrophysiology, Armed Forced Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan, from Oct 2020 to Mar 2021.

Methodology: Three groups of patients with different accessory pathway (AP) location using surface ECG delta wave in WolfParkinson-White syndrome were made. The base line echocardiographic features of left ventricle as left ventricle ejection fraction (LVEF), regional structural changes and regional wall motion abnormalities (RWMA) were taken using 2D mode. The time from systolic posterior septal motion to early systolic posterior wall motion with reference to onset of QRS was calculated using M-Mode echocardiography in these three groups of patients with White syndrome before ablation and post radiofrequency ablation.

Results: Out of 38 patients, 17 (44.71%) patients were having right free wall (group 1), 12 (31.6%) patients were having right postero-septal (group 2) and 9 (23.7%) patients were having left free wall (group 3) accessory pathways (accessory pathways). There were significant differences in septal to posterior wall motion delay seen between the three groups (p<0.05) and was very much higher in group 1 (p<0.05). After ablation, left ventricle ejection fraction was raised very much in patients having right-sided free wall and post-eroseptal accessory pathway as compared to left sided free wall accessory pathway (p<0.05) and
LV diastolic dimension was decreased more in right sided post-eroseptal accessory pathways (p<0.05).

Conclusion: Right-sided accessory pathway cause ventricular wall motion and left ventricle systolic function to be reduced, resulting in a lower left ventricle ejection fraction and a larger left ventricle end-diastolic size. These effects, including left ventricle dys-synchrony was very much improved after radiofrequency ablation