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Electrogram Patterns Predictive of Successful Radiofrequency Catheter Ablation of Accessory Pathways
Author(s) -
HAISSAGUERRE M.,
FISCHER B.,
WARIN J.F.,
DARTIGUES J.F.,
LEMÉTAYER Ph.,
EGLOFF Ph.
Publication year - 1992
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1992.tb03037.x
Subject(s) - medicine , ablation , cardiology , catheter ablation , accessory pathway , radiofrequency ablation , radiofrequency catheter ablation
We assessed anterograde conduction electrogram parameters at successful ablation sites according to accessory pathway (AP) location and compared them to the most favorable electrograms at unsuccessful sites. A median of three radiofrequency energy impulses was applied to ablate 97% of 136 APs versus four impulses to ablate 90% of 65 concealed APs. Electrograms at successful sites showed variable A/V ratio (0.04‐7), and a QS pattern of unipolar ventricular wave in 90%. Electrograms were different in right versus left AP: AV time 29 ± 7 versus 38 ± 10; and timing of ventricular deflection: 17 ± 9 versus 2 ± 9 msec, respectively. Analysis in each patient of the mapping parameters at successful versus “most favorable” unsuccessful sites showed an improvement in at least one parameter in 55%, no apparent change in all parameter values in 30%, and even less favorable parameters in 15% of patients. In patients with manifest AP, overall comparison of elecfrograms at successful versus unsuccessful sites showed no difference in A/V ratio (1.3 ± 1.5 vs 2.2 ± 1.6), unipolar pattern distribution, and AV time (34 ± 10 vs 35 ± 9), but earlier bipolar main ventricular potential (‐4 ± 12 vs ‐1.5 ± 10 msec) and unipolar intrinsic deflection timings (‐5.2 ± 11 vs ‐1.8 ± 10 msec). In patients with concealed AP, a retrograde continuous electrical activity was recorded in 72% of successful versus 38% of unsuccessful sites (P = 0.03). Conclusions: Electrogram characteristics at successful radiofrequency ablation are different in right and left manifest AP. The timing of the ventricular potential is the only predictive electrogram parameter. Individual analysis of electrograms in each patient shows the better criteria in 55% of successful sites but no improvement in criterion values in 45%.