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- Title
Electrocardiographic and Electrophysiologic Predictors of Successful Ablation Site in Patients with Manifest Posteroseptal Accessory Pathway.
- Authors
HAGHJOO, MAJID; MAHMOODI, EBRAHIM; FARJAM FAZELIFAR, AMIR; ALIZADEH, ABOLFATH; JAFAR HASHEMI, MOHAMMAD; EMKANJOO, ZAHRA; ALI SADR‐AMELI, MOHAMMAD
- Abstract
Background: Prediction of accessory pathway (AP) location before radiofrequency ablation has become increasingly important for patients with AP; this is especially true for posteroseptal (PS) APs. Objective: To identify electrocardiographic and electrophysiologic predictors of pathway location in patients with manifest posteroseptal AP. Methods: A detailed electrocardiographic analysis, electrophysiologic study, and ablation were performed in 94 patients with single manifest posteroseptal AP (mean age 35.0 ± 13.8 years; 56 males). Results: Localization was right PS in 68 patients, left PS in 19 patients, and coronary sinus and its branches in seven patients. Common to all the patients with posteroseptal AP was a negative delta in at least two inferior leads. The most sensitive and specific parameter for differentiating left posteroseptal APs from right posteroseptal APs was an R/S ratio ≥1.0 in lead V1 (sensitivity 100% and specificity 100%). The R-wave amplitude in lead I (sensitivity 54%, specificity 67%), and delta ventricularatrial interval (sensitivity 75%, specificity 87%) had much lesser sensitivity and specificity in this regard. The epicardial posteroseptal APs were discriminated from endocardial variant by the positive delta in aVR (sensitivity 71% and specificity 99%) and negative delta in II (sensitivity 100% and specificity 20%). Delta wave polarity in V1 was not helpful for differentiating right-sided from left-sided posteroseptal APs. Conclusions: This study demonstrated that in patients with posteroseptal AP, successful ablation site could be predicted to be on the right or left endocardial surface using R/S ratio in lead V1. Necessity for Coronary sinus catheterization and angiography is predictable using delta wave polarities in leads aVR and II.
- Subjects
RADIO frequency; MEDICAL radiography; ELECTROCARDIOGRAPHY; ELECTROPHYSIOLOGY; CATHETERIZATION
- Publication
Pacing & Clinical Electrophysiology, 2008, Vol 31, Issue 1, p103
- ISSN
0147-8389
- Publication type
Article
- DOI
10.1111/j.1540-8159.2007.00933.x