[Magnetocardiographic localization of an accessory pathway in patients with WPW syndrome]

Abstract

The usefulness of magnetocardiography (MCG) in determining the location of an accessory pathway (Kent bundle) was examined by the isomagnetic map at the time of a delta wave, and by gated magnetic resonance imaging (MRI). MCG was performed at 36 points on the anterior chest wall in eight cases with Wolff-Parkinson-White (WPW) syndrome using a SQUID (superconducting quantum interference device) system with the second derivative gradiometer. Based on these records, isomagnetic maps during the QRS and T waves were constructed, and the depth of the accessory pathway from the coil was calculated mathematically. The locations of the accessory pathways were estimated using these data and the MRI findings. The locations of the accessory pathways thus determined were compared with findings obtained by body surface maps. A dipole directed towards the left was deduced, because the maximum was located more superiorly than the minimum in an isomagnetic map 10-40 msec after onset of the delta wave in cases with WPW syndrome, indicating an accessory pathway to be located in the right ventricle. A dipole directed towards the right was deduced, because the maximum was located more superiorly than the minimum in an isomagnetic map 10-40 msec after onset of the delta wave of cases with WPW syndrome indicating an accessory pathway to be located in the left ventricle. Assuming the electric current source is a single dipole, the location of a current dipole might be determined by positions of the maximum and the minimum in the isomagnetic maps. In the present study, the locations as determined by analysis of the isomagnetic map 40 msec after onset of the delta wave and the gated MRI were concordant with the findings obtained by body surface isopotential maps. Furthermore, some cases showed two opposing dipoles on the isomagnetic map at the peak of the T wave in lead II of the standard ECG leads; one directed to the left expressing normal repolarization; the other directed to the right presumably expressing repolarization of the myocardium which was excited by an impulse via the accessory pathway. The location of the current dipole as determined by analysis of the isomagnetic map at the peak of the T wave in lead II was nearly the same as the position of the current dipole as determined by analysis of the isomagnetic map 40 msec after onset of the delta wave.(ABSTRACT TRUNCATED AT 400 WORDS)