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  • Title: Electrocardiographic and electrophysiologic predictors of successful ablation site in patients with manifest posteroseptal accessory pathway.
    Author: Haghjoo M, Mahmoodi E, Fazelifar AF, Alizadeh A, Hashemi MJ, Emkanjoo Z, Sadr-Ameli MA.
    Journal: Pacing Clin Electrophysiol; 2008 Jan; 31(1):103-11. PubMed ID: 18181918.
    Abstract:
    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 >or=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.
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