SUCCESSFUL RADIOFREQUENCY ABLATION OF ACCESSORY PATHWAYS WITH THE FIRST ENERGY DELIVERY - THE ANATOMIC AND ELECTRICAL CHARACTERISTICS

XIE B HEALD SC CAMM AJ ROWLAND E WARD DE

B. Xie et al., SUCCESSFUL RADIOFREQUENCY ABLATION OF ACCESSORY PATHWAYS WITH THE FIRST ENERGY DELIVERY - THE ANATOMIC AND ELECTRICAL CHARACTERISTICS, European heart journal, 17(7), 1996, pp. 1072-1079

12

INGLESE

Article

Cardiac & Cardiovascular System

European heart journal → ACNP

0195-668X

17

7

1996

1072 - 1079

ISI

0195-668X(1996)17:7<1072:SRAOAP>2.0.ZU;2-R

Successful ablation of accessory pathways has been achieved at the fir st energy delivery site in some patients, but factors permitting succe ss at the first site are unclear. Accessory pathway location, surface and endocardial electrogram characteristics in each location were anal ysed and compared between the patients with first site block (group A, 34 patients) and those in whom multiple sites (median seven sites) we re required (group B, 133 patients). No patients with right free-wall pathways had first site block. In group A surface electrocardiograms w ere more pre-excited (QRS duration: 132+/-20 vs 120+/-17 ms, P<0 . 01) . For left free-wall and septal pathways, the interval from the onset of the earliest delta wave on surface electrocardiogram to local ventr icular activation (QRS-V) was more negative and the local atrioventric ular interval (AV) was shorter in group A; the positive predictive val ue of a QRS-V less than or equal to 0 ms, an AV less than or equal to 30 ms and the presence of a possible accessory pathway potential was 6 7% for left free-wall and of a QRS-V less than or equal to-10 ms with an AV less than or equal to 30 ms was 100% for septal pathways. During retrograde mapping of concealed left free-wall and right anteroseptal pathways (first site block was not achieved in other locations) the p ositive predictive value of a local ventriculoatrial interval less tha n or equal to 30 ms was 55%. Accessory pathway location correlated str ongly with the chances of first site block, suggesting that anatomical features are important. Maximizing pre-excitation may be of benefit i n achieving first site block. Delivery of energy to a site with specia l endocardial electrogram features was associated with an increased li kelihood of first site block.