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CLINICAL STUDIES

Gated blood-pool SPECT evaluation of changes after radiofrequency catheter ablation of accessory pathways

Evidence for persistent ventricular preexcitation despite successful therapy

Philippe Chevalier, MD, PhD^*, Laurence Bontemps, PhD, Marjaneh Fatemi, MD^*, Stephane Velon, MD^*, Eric Bonnefoy, MD^*, Gilbert Kirkorian, MD^*, Roland Itti, MD and Paul Touboul, MD^*

^* Service de Cardiologie et Soins Intensifs, BP Lyon-Montchat 69394 Lyon Cedex 03, France
Service de Médecine Nucléaire Hôpital Cardiovasculaire et Pneumologique Louis Pradel, BP Lyon-Montchat 69394 Lyon Cedex 03, France

Manuscript received June 1, 1998; revised manuscript received May 18, 1999, accepted August 12, 1999.

Reprint requests and correspondence: Dr. Paul Touboul, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, BP Lyon-Montchat 69394 Lyon, Cedex 03, France

OBJECTIVES

This study was designed to prospectively evaluate the effects of radiofrequency ablation in Wolff-Parkinson-White (WPW) syndrome by scintigraphic analysis.

BACKGROUND

The functional changes triggered by radiofrequency current ablation of atrioventricular accessory pathways are not fully known.

METHODS

Forty-four patients with WPW syndrome were consecutively investigated before and 48 h after radiofrequency therapy. Fourteen patients had right sided atrioventricular pathways and 30 patients had left sided bypass-tracts. Planar gated imaging and gated blood pool tomography were performed in all of these patients.

RESULTS

A significant increase in the left ventricular ejection fraction (LVEF) was demonstrated in patients with left preexcitation (62.2 ± 7.9% before ablation against 64.4 ± 6.3% after ablation, p = 0.02) but not for those with right sided anomalous pathway. Phase analysis only gave significant differences following ablation of right sided pathways (left-to-right phase difference = 14.4 ± 13.8° before ablation versus 7.5 ± 7.2° after ablation, p < 0.05). Early abnormal ventricular contraction persisted in 12 patients with right accessory pathways and in 8 patients with left accessory pathways despite the complete disappearance of any abnormal conduction as proven electrophysiologically.

CONCLUSIONS

Following catheter ablation of atrioventricular accessory pathways: 1) an improvement of left ventricular function may be seen, particularly in patients with left sided accessory pathways, and 2) unexpected persistence of local ventricular preexcitation at the site of successful ablation may be detected.

Abbreviations and Acronyms   L-RMP = difference of the mean phases of the left and right ventricles   LVEF = left ventricular ejection fraction   LVMP = mean phase of the left ventricle   LVPSD = standard deviation of the mean left ventricular phases   RVEF = right ventricular ejection fraction   RVMP = mean phase of the right ventricle   RVPSD = standard deviation of the mean right ventricular phases   WPW = Wolff-Parkinson-White