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Electrocardiographic Identification of Mid‐Septal Accessory Pathways in Close Proximity to the Atrioventricular Conduction System
Author(s) -
LORGA F° ADALBERTO,
SOSA EDUARDO,
SCANAVACCA MAURICIO,
D'AVILA ANDRÉ,
KUNIYOSHI RICARDO,
HORTA JOSÉ,
FENELON GUILHERME,
BRUGADA PEDRO
Publication year - 1996
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.1540-8159.1996.tb03266.x
Subject(s) - medicine , qrs complex , cardiology , accessory pathway , ablation , electrical conduction system of the heart , lead (geology) , precordial examination , t wave , electrocardiography , catheter ablation , anatomy , geomorphology , geology
In order to identify ECG characteristics of overt midseptal accessory pathways (APs) predictive of close proximity to the AV conduction system we analyzed data from patients who underwent successful RF catheter ablation of a mid‐septal AP, Mean patient age was 31 ± 16 years, and 13 were male. The 40° right anterior oblique view was used to divide the mid‐septal area into 3 zones: 1 (anteriorportion); 2 (intermediate); and 3 (posterior portion). The 12‐lead ECG was analyzed with regard to delta wave polarity and R/S transition in the precordial leads. The findings from patients ablated at zone 3 were compared to those at zones 1 and 2. All patients had a positive delta wave in the leads I, II, aVL, and negative delta wave in the leads III and aVR. The R/S transition occurred in lead V 2 in 80% of patients. The delta wave in lead aVF was the only ECG characteristic that correlated with the AP ablation zone. Six of 8 patients ablated at zone 3 had a negative delta wave in lead aVF while 6 out of 7 patients ablated at zone 1 or 2 had a positive or isoelectric delta wave in lead aVF (P = 0.03). A positive or isoelectric delta wave in lead aVF identifies mid‐septal AP in close proximity to the AV conduction system.