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  • Title: Electrocardiographic and electrophysiologic characteristics of anteroseptal, midseptal, and para-Hisian accessory pathways. Implication for radiofrequency catheter ablation.
    Author: Tai CT, Chen SA, Chiang CE, Lee SH, Chang MS.
    Journal: Chest; 1996 Mar; 109(3):730-40. PubMed ID: 8617084.
    Abstract:
    STUDY OBJECTIVE: To investigate the ECG characteristics, the electrophysiologic properties, and an effective radiofrequency catheter ablation technique in patients with septal accessory pathways. PATIENTS: Forty-six consecutive subjects with septal accessory pathways located in the anteroseptal, midseptal, and para-Hisian areas. DESIGN AND INTERVENTIONS: ECGs obtained during sinus rhythm and orthodromic tachycardia, conduction properties obtained from electrophysiologic study, and results of two different ablation techniques were analyzed. MEASUREMENTS AND RESULTS: (1) Twenty-four (52.2%) had manifest preexcitation and 15 (32.6%) had multiple accessory pathways; (2) midseptal pathways could be differentiated from anteroseptal and para-Hisian pathways by a negative delta wave in lead III and a biphasic delta wave in lead aVF during sinus rhythm, and a negative retrograde P wave in two inferior leads during orthodromic tachycardia; (2) midseptal pathways had better antegrade conduction properties and a significantly higher incidence (61.5%) of inducible atrial fibrillation; (4) radiofrequency catheter ablation using lower energy (20+/-6 W) had a comparable effect to ablation using higher energy (36+/-5 W), but without impairment of atrioventricular (AV) node conduction or development of AV block; and (5) during the follow-up period of 26+/-14 months (range, 5 to 54 months), three (6.5%) patients had recurrence. CONCLUSIONS: Midseptal accessory pathways had ECG and electrophysiologic characteristics that were distinctive from those of anteroseptal and para-Hisian pathways. Catheter ablation of these septal pathways using low radiofrequency energy was safe and effective.
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