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Electrocardiographic and Electrophysiologic Predictors of Successful Ablation Site in Patients with Manifest Posteroseptal Accessory Pathway
Author(s) -
HAGHJOO MAJID,
MAHMOODI EBRAHIM,
FARJAM FAZELIFAR AMIR,
ALIZADEH ABOLFATH,
JAFAR HASHEMI MOHAMMAD,
EMKANJOO ZAHRA,
ALI SADRAMELI MOHAMMAD
Publication year - 2008
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.1540-8159.2007.00933.x
Subject(s) - medicine , coronary sinus , cardiology , ablation , radiofrequency ablation , catheter ablation , electrocardiography
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.