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(Circulation. 1997;96:1566-1574.)
© 1997 American Heart Association, Inc.

Articles

Body-Surface Distribution of Changes in Activation-Recovery Intervals Before and After Catheter Ablation in Patients With Wolff-Parkinson-White Syndrome

Clinical Evidence for Ventricular `Electrical Remodeling' With Prolongation of Action-Potential Duration Over a Preexcited Area

Makoto Akahoshi, MD; Makoto Hirai, MD; Yasuya Inden, MD; Hiroaki Sano, MD; Atsuya Shimizu, MD; Takahisa Kondo, MD; Mitsutaka Makino, MD; Mitsuru Horiba, MD; Yukihiko Yoshida, MD; Naoya Tsuboi, MD; Haruo Hirayama, MD; Teruo Ito, MD; Hiroshi Hayashi, MD; ; Hidehiko Saito, MD

From the Division of Cardiology, First Department of Internal Medicine, University of Nagoya School of Medicine (M.A., M. Hirai, Y.I., H. Sano, A.S., T.K., M.M., M. Horiba, H. Hayashi, H. Saito), and the Division of Cardiology, Nagoya Daini Red Cross Hospital (Y.Y., N.T., H. Hirayama, T.I.), Japan.

Correspondence to Makoto Hirai, MD, Division of Cardiology, First Department of Internal Medicine, University of Nagoya School of Medicine, 65 Tsurumai, Showaku, Nagoya 466, Japan.

Background T-wave abnormalities after catheter ablation in patients with manifest Wolff-Parkinson-White (WPW) syndrome have been attributed to a continuation of repolarization abnormalities induced by preexcitation (cardiac memory).

Methods and Results To clarify changes in repolarization properties, we analyzed the activation-recovery interval (ARI) obtained from body-surface maps and the relationship between the activation time (AT) and ARI in 30 patients with WPW syndrome (group A, 18 patients with manifest left-sided accessory pathway; group B, 7 patients with manifest right-sided accessory pathway; and group C, 5 patients with concealed left-sided accessory pathway) before, 1 day after, and 1 week after ablation. The ARI significantly decreased 1 week after ablation compared with before and 1 day after ablation over the preexcited area in groups A and B. Correlation coefficients between the AT and ARI showed a significantly (P<.01) stronger inverse relationship before (r=-.58) and 1 week after (r=-.64) ablation than 1 day after ablation (r=-.46) in groups A and B. In group C, the ARI and correlation coefficients between the AT and ARI showed no significant changes.

Conclusions These findings suggest a prolongation of the action-potential duration over the preexcited area before and just after ablation as ventricular "electrical remodeling," a decrease in the inverse relationship between the AT and action-potential duration 1 day after ablation, and a gradual recovery of the action-potential duration over the preexcited area and inverse relationship 1 week after ablation.

Key Words: ablation • action potentials • remodeling • mapping

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