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(Circulation. 2008;118:907-915.)
© 2008 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Cardiac Memory in Patients With Wolff-Parkinson-White Syndrome

Noninvasive Imaging of Activation and Repolarization Before and After Catheter Ablation

Subham Ghosh, MS; Edward K. Rhee, MD; Jennifer N. Avari, MD; Pamela K. Woodard, MD; Yoram Rudy, PhD

From the Cardiac Bioelectricity and Arrhythmia Center (S.G., E.K.R., P.K.W., Y.R.), Department of Biomedical Engineering (S.G., Y.R.), and Mallinckrodt Institute of Radiology (P.K.W., Y.R.), Washington University, St Louis, Mo; Division of Pediatric Cardiology, Washington University School of Medicine/St Louis Children’s Hospital, St Louis, Mo (J.N.A., Y.R.); and Eller Congenital Heart Center, Heart Lung Institute, St Joseph’s Hospital and Medical Center, Phoenix, Ariz (E.K.R.).

Correspondence to Yoram Rudy, PhD, Cardiac Bioelectricity Center, 290 Whitaker Hall, Campus Box 1097, One Brookings Dr, St. Louis, MO 63130–4899. E-mail rudy{at}wustl.edu

Received March 21, 2008; accepted June 6, 2008.

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 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.

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CLINICAL PERSPECTIVE

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Clinical Summaries
Circulation 2008 118: 897-898. [Extract] [Full Text]

This article has been cited by other articles:

				T. Berger, F. Hintringer, and G. Fischer Letter by Berger et al Regarding Article, "Cardiac Memory in Patients With Wolff-Parkinson-White Syndrome: Noninvasive Imaging of Activation and Repolarization Before and After Catheter Ablation" Circulation, February 24, 2009; 119(7): e209 - e209. [Full Text] [PDF]

				Y. Rudy, S. Ghosh, E. K. Rhee, J. N. Avari, and P. K. Woodard Response to Letter Regarding Article, "Cardiac Memory in Patients With Wolff-Parkinson-White Syndrome: Noninvasive Imaging of Activation and Repolarization Before and After Catheter Ablation" Circulation, February 24, 2009; 119(7): e210 - e210. [Full Text] [PDF]