Document Detail

Specific electrocardiographic features of manifest coronary vein posteroseptal accessory pathways.
MedLine Citation:
PMID:  9817553     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Some posteroseptal accessory pathways (APs) can be successfully ablated by radiofrequency current only from inside the coronary sinus (CS) or its branches, because of an absolute or relatively epicardial location. The aim of this study was to identify ECG features of manifest posteroseptal APs requiring ablation in the CS or the middle cardiac veins (MCVs). METHODS AND RESULTS: One hundred seventeen consecutive patients with manifest posteroseptal APs successfully ablated: (1) > or = 1 cm deep inside the MCV (group MCV: n = 13); (2) inside the CS, including the area adjacent to the MCV ostium (group CS: n = 10); (3) at the right (group R: n = 60); or (4) the left posteroseptal endocardial region (group L: n = 34) were included. We reviewed delta wave polarity (initial 40 msec) and QRS morphology during sinus rhythm and atrial pacing as well as electrogram characteristics in these patients. The local target site electrogram in groups MCV and CS was characterized by a longer atrial to ventricular electrogram interval, suggesting a longer course of the pathway and more frequent recording of a presumptive AP potential compared to the group ablated at the right or left endocardium. The most sensitive ECG feature for group CS or group MCV was a negative delta wave in lead II in sinus rhythm (87%), but specificity (79%) and positive predictive value (50%) were relatively low. A steep positive delta wave in aVR during maximal preexcitation possessed the highest specificity and positive predictive value (98% and 88%, sensitivity 61%) which increased to 99% and 91%, respectively, when combined with a deep S wave in V6 (R wave < or = S wave). CONCLUSION: These data suggest that posteroseptal APs ablated inside the coronary venous system have highly specific features, including the combination of a steep positive delta wave in lead aVR and a deep S wave in lead V6 (R wave < or = S wave) during maximal preexcitation. The highest sensitivity is provided by a negative delta wave in lead II. These findings may be helpful for anticipating and planning an epicardial ablation strategy.
A Takahashi; D C Shah; P Jaïs; M Hocini; J Clementy; M Haïssaguerre
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  9     ISSN:  1045-3873     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  1998 Oct 
Date Detail:
Created Date:  1999-01-22     Completed Date:  1999-01-22     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1015-25     Citation Subset:  IM    
Service d'Electrophysiologie Cardiaque, Hopital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France.
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MeSH Terms
Aged, 80 and over
Catheter Ablation / methods
Catheterization, Peripheral
Coronary Vessels
Heart Conduction System / abnormalities,  physiopathology*,  surgery
Heart Septum / innervation*,  surgery
Middle Aged
Predictive Value of Tests
Retrospective Studies
Comment In:
J Cardiovasc Electrophysiol. 1999 Mar;10(3):422   [PMID:  10210509 ]

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