The Wolff–Parkinson–White Syndrome

Among patients with a Wolff–Parkinson–White (WPW) syndrome, approximately half will experience arrhythmia during their lifetime. Radiofrequency catheter ablation of the accessory atrioventricular pathway is the treatment of choice for this condition and is associated with a high success rate. Electrophysiology study is indeed the key procedure for identifying the target of radiofrequency ablation. The present prospective study, published in this issue of Circulation: Cardiovascular Imaging by Ishizu et al, investigated the ability of a new imaging technology based on 3-dimensional speckle-tracking (ST) strain echocardiography in localizing AP in WPW syndrome. This tool, named isochrone activation imaging (AI), was accurate enough to assess synchronized activation in the normal heart and to detect contractile abnormalities, which approximately matched ablation site in WPW patients with leftor right-sided AP.