Agata Duszańska

Evaluation of left ventricular systolic and diastolic function in patients with atrioventricular re-entrant tachycardia treated by radiofrequency current ablation.

Little is known about the long-term influence of radiofrequency current ablation (RFCA) on left ventricular (LV) systolic and diastolic function in patients with atrioventricular re-entrant tachycardia (AVRT). Method — The study group consisted of 65 patients (33 M, mean age 39 ± 11 y) with WPW syndrome and recurrent episodes of AVRT without any concomitant diseases.The control group consisted of 50 age-matched healthy volunteers. In both study and control groups transthorasic echocardiography (TTE) and Doppler were performed in order to assess LV systolic and diastolic function. In WPW patients TTE was followed by electrophysiology study and RFCA. TTE was repeated in 6-months time in the study group. Results — At 6-month follow-up a decrease in LV end-systolic diameters (1.77 ± 0.22 vs. 1.67 ± 0.22 cm/m2, P < 0.001) and volumes (20 ± 6 vs. 17 ± 5 ml, P < 0.001) and an increase in LV FS (33 ± 6 vs. 37 ± 5%, P < 0.001), EF (54 ± 6 vs. 60 ± 5%, P < 0.001), IVS (44 ± 13 vs. 49 ± 14%, P < 0.05) and LV PW thickening (58 ± 19 vs. 62 ± 16%, P < 0.05) was found. Doppler analysis revealed an increase in E wave (78 ± 17 vs. 82 ± 14 cm/s, P < 0.001), E/A ratio (1.14 ± 0.37 vs. 1.33 ± 0.24, P < 0.001) and a decrease in A wave (68 ± 19 vs. 63 ± 12 cm/s, P < 0.05), DT (219 ± 33 vs. 180 ± 20 ms, P < 0.001), IVRT (105 ± 13 vs. 88 ± 13 ms, P < 0.001), AR (26 ± 8 vs. 18 ± 12 cm/s, P < 0.001) and difference between duration of AR and A waves (5 ± 24 vs. –12 ± 21 ms, P < 0.001). No significant differences in regard to LV systolic and diastolic variables were found between patients and controls post RFCA. Conclusion — RFCA of accessory pathway in patients with WPW syndrome and AVRT is associated with improvement of LV systolic and diastolic function.

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

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.

Myocardial perfusion scintigraphy – interpretation of gated imaging. Part 2

The first part of the review describes the basic aspects of interpreting myocardial perfusion defects in single photon emission computed tomography (SPECT) scintigraphy. It also presents indications for invasive diagnostics based on stress perfusion defects. This article provides basic information concerning the interpretation of gated SPECT imaging, including such parameters as left ventricular wall motion and thickening as well as left ventricular wall systolic and diastolic function. Gated examination combined with the assessment of myocardial perfusion reduces the rate of false positives results of myocardial perfusion scintigraphy in perfusion tests, additionally providing data on left ventricular systolic and diastolic function.

Interpreting myocardial perfusion scintigraphy using single-photon emission computed tomography. Part 1

This article discusses the protocol for myocardial perfusion scintigraphy performed with single-photon emission computed tomography (SPECT). Indications for SPECT are listed with consideration given to the results of the increasingly more common angio-CT examinations of the coronary arteries (multislice computed tomography). The paper also presents basic information about interpreting the results, including the scores of left ventricle myocardial perfusion using the 17-segment polar map, and explains the concept of total perfusion deficit.