The influence of accessory pathway localization on left ventricular mechanics in adult patients with Wolff-Parkinson-White syndrome: a speckle-tracking echocardiographic investigation

Q: What are the key findings of this study?

Septal and right accessory pathways in patients with Wolff-Parkinson-White syndrome were associated with significantly lower left ventricular ejection fraction (59.2% and 59.8%, respectively) compared to healthy controls (65.0%).

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Wolff-Parkinson-White syndrome (n=147). Intervention: Septal and right accessory pathways vs. Healthy controls. Primary outcome: Left ventricular ejection fraction (LVEF) (p=<0.001).

Q: What does this research mean for the field?

In Wolff-Parkinson-White syndrome, left ventricular mechanical dysfunction depends on accessory pathway location, with septal and right pathways inducing widespread strain impairment, mechanical dyssynchrony, and reduced ejection fraction, while left pathways primarily impair circumferential strain. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To quantify and compare left ventricular deformation and mechanical synchrony across anatomical accessory pathway subgroups in adults with Wolff-Parkinson-White syndrome.

Mingxia Li; Fen Chen; Jing Yao; Xinmin Chen; Xiaoxian Wang; Beibei Ge; Fang Xu; Pingyang Zhang; Shukui Wang

doi:10.21037/qims-2026-1-0046

July 27, 2026Quantitative Imaging in Medicine and SurgeryOpen Access

The influence of accessory pathway localization on left ventricular mechanics in adult patients with Wolff-Parkinson-White syndrome: a speckle-tracking echocardiographic investigation

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Key result

Septal and right accessory pathways in WPW are linked to ~6-point lower LVEF vs. controls.

P<0.001
n=147

Figures

Why the study?

The specific impact of accessory pathway location on left ventricular mechanics in Wolff-Parkinson-White syndrome remains incompletely characterized.

Does accessory pathway location affect left ventricular deformation and mechanical synchrony in adult patients with Wolff-Parkinson-White syndrome?

Key Points

To quantify and compare left ventricular deformation and mechanical synchrony across anatomical accessory pathway subgroups in adults with Wolff-Parkinson-White syndrome.
Retrospective analysis of 91 patients with Wolff-Parkinson-White syndrome (mean age 38.2±1.4 years) and 56 matched controls using two-dimensional speckle-tracking echocardiography.
Patients were categorized by accessory pathway location: septal (n=34), right (n=38), and left (n=19).
Assessed left ventricular circumferential strain, longitudinal strain, radial strain, and mechanical synchrony via peak strain dispersion.
Left ventricular ejection fraction was significantly lower in septal (59.2%±1.2%) and right (59.8%±1.0%) accessory pathway groups compared to controls (65.0%±0.3%; both P<0.001), but remained preserved in the left group (62.2%±0.9%).
Global circumferential strain was decreased in all patient groups versus controls (-19.0%±0.7%, -19.3%±0.6%, -19.2%±0.8% vs. -23.1%±0.4%; P<0.001), while septal and right pathways also caused significant impairments in global longitudinal strain, radial strain, and longitudinal peak strain dispersion (P<0.001).
Left ventricular ejection fraction correlated inversely with global longitudinal strain (r=-0.53, P<0.001) and longitudinal peak strain dispersion (r=-0.41, P<0.001).

Study Design

Type

Cross-Sectional (n=147)

Multicenter

Yes

Structured PICO

Does accessory pathway location affect left ventricular deformation and mechanical synchrony in adult patients with Wolff-Parkinson-White syndrome?

P

Population

147 adults, including 91 patients with Wolff-Parkinson-White syndrome and 56 healthy matched controls, underwent cross-sectional evaluation of left ventricular mechanics.

E

Exposure

Septal, right free-wall, or left free-wall accessory pathways (as identified by electrophysiological mapping)

C

Comparator

56 age- and sex-matched healthy controls without structural or functional heart disease

O

Outcome

Global and regional left ventricular deformation (longitudinal, circumferential, and radial strain) and mechanical synchrony (peak strain dispersion) measured by two-dimensional speckle-tracking echocardiographysurrogate

Main Result

Absolute Event Rate: 59.2% vs 65%

p-value: p=<0.001

Limitations

Modest sample size limits the ability to perform detailed subgroup analyses.
Cross-sectional design precludes establishing causality or tracking the progression of mechanical dysfunction over time.
Lack of longitudinal assessments and post-ablation follow-up data to determine reversibility of abnormalities.
Modest sample size
Cross-sectional design precludes establishing causality or tracking progression of mechanical dysfunction over time
Lack of post-ablation follow-up data to determine reversibility

Implication

In adults with Wolff-Parkinson-White syndrome, septal and right accessory pathways are associated with more widespread left ventricular mechanical dyssynchrony and reduced ejection fraction compared to left-sided pathways, suggesting location-specific impacts on global pump performance.

Abstract

Background: Ventricular pre-excitation can cause left ventricular (LV) mechanical dyssynchrony and dysfunction. However, the specific impact of accessory pathway (AP) location on LV mechanics remains incompletely characterized. This study utilized two-dimensional speckle-tracking echocardiography (2D-STE) to quantify and compare LV deformation and synchrony across these anatomical subgroups. Methods: We retrospectively analyzed 91 patients with Wolff-Parkinson-White (WPW) syndrome (age 38.2±1.4 years) and 56 matched controls using 2D-STE. Global and regional LV deformation and synchrony were compared across AP-location groups: septal (n=34), right (n=38), and left (n=19). LV deformation parameters included circumferential strain (CS), longitudinal strain (LS), and radial strain (RS). LV synchrony was assessed by peak strain dispersion (PSD) of LV segments for each strain direction. Results: controls (65.0%±0.3%; P<0.001). LVEF correlated negatively with GLS (r=-0.53, P<0.001) and with GLS-PSD (r=-0.41, P<0.001). Conclusions: LV mechanical dysfunction in WPW syndrome varies by AP location. Septal and right APs lead to widespread strain impairment, dyssynchrony, and lower LVEF, whereas left APs mainly reduce CS. Reduced LVEF is closely associated with impaired LV mechanics and dyssynchrony.

Discussion

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Cite This Study

Li et al. (2026) conducted a cross-sectional in Wolff-Parkinson-White syndrome (n=147). Septal and right accessory pathways vs. Healthy controls was evaluated on Left ventricular ejection fraction (LVEF) (p=<0.001). Septal and right accessory pathways in patients with Wolff-Parkinson-White syndrome were associated with significantly lower left ventricular ejection fraction (59.2% and 59.8%, respectively) compared to healthy controls (65.0%).

synapsesocial.com/papers/6ad0fc513afa093ea9acfd35 https://doi.org/10.21037/qims-2026-1-0046

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The influence of accessory pathway localization on left ventricular mechanics in adult patients with Wolff-Parkinson-White syndrome: a speckle-tracking echocardiographic investigation

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

The influence of accessory pathway localization on left ventricular mechanics in adult patients with Wolff-Parkinson-White syndrome: a speckle-tracking echocardiographic investigation

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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