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Rabah H, Khalaf Z, Chaddad R, Kazem H, Ahmad B, Mansour H, Saleh M, Boushnak M, Moussa MK, Rabah A. The Correlation Between Gender and Accessory Pathways. Cureus 2021; 13:e14746. [PMID: 34084674 PMCID: PMC8164102 DOI: 10.7759/cureus.14746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Accessory pathways (APs) are muscular bundles capable of rapid conduction between atria and ventricles. They can be located anywhere along the atrioventricular groove or septum. The etiology of such pathways is generally unknown. This study aims to evaluate the correlation between gender, AP location, and clinical presentation. Methods This is a retrospective study of 139 patients who underwent radiofrequency ablations for newly diagnosed accessory pathways between years 2010 and 2016. Information extracted from the medical records included: age at the time of diagnosis, gender, characteristics, and anatomical location of the accessory pathways. Results A total of 139 patients with AP were enrolled in the study. The mean age of diagnosis was 32.2 ± 13.5 years. With regards to gender, APs were more common among men (p-value 0.04). Males were predominant in both the right and left AP groups (p-value 0.025), although, overall, most of the AP were left located. Also, males were more commonly diagnosed with right posteroseptal (RPS) accessory pathways while females with left lateral (LL) pathways. Concerning the clinical presentation, the manifest form was more frequent than concealed. Males were prevalent in both groups (p-value 0.38). Conclusion Gender components might have a role in the pathogenesis of AP formation.
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Affiliation(s)
- Hussein Rabah
- Internal Medicine, Staten Island University Hospital, Northwell Health, New York, USA
| | - Zaynab Khalaf
- Endocrinology, Diabetes and Metabolism, Lebanese University, Faculty of Medical Sciences, Al Hadath, LBN
| | - Rima Chaddad
- Interventional Cardiology, Lebanese University, Faculty of Medicine, Al Hadath, LBN
| | - Hassan Kazem
- Electrophysiology, Beirut Cardiac Institute, Beirut, LBN
| | - Bassam Ahmad
- Cardiology, Lebanese University, Faculty of Medical Sciences, Al Hadath, LBN
| | - Hassan Mansour
- Electrophysiology, Beirut Cardiac Institute, Beirut, LBN
| | - Mohammad Saleh
- Internal Medicine, Lebanese University, Faculty of Medicine, Al Hadath, LBN
| | - Mohammad Boushnak
- Orthopedics and Traumatology, Lebanese University, Faculty of Medicine, Al Hadath, LBN
| | - Mohamad K Moussa
- Orthopedic Surgery, Lebanese University, Faculty of Medical Sciences, Al Hadath, LBN
| | - Ali Rabah
- Electrophysiology, Beirut Cardiac Institute, Beirut, LBN
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Kabul HK, Ulus T, Barcın C, Unlu M, Samedli S, Kose S. Electrocardiographic estimation of successful ablation site in patients with manifest inferior paraseptal accessory pathway. J Electrocardiol 2016; 49:132-8. [PMID: 26852930 DOI: 10.1016/j.jelectrocard.2015.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Indexed: 11/16/2022]
Abstract
Inferior paraseptal accessory pathways (APs) have a wide distribution and prediction of AP location before radiofrequency ablation is very important in such pathways. We aimed to estimate successful ablation site based on electrocardiogram in 137 patients (mean age: 25.8±9.0; 126 males) with single manifest inferior paraseptal AP. Right endocardial inferior paraseptal APs were discriminated from left endocardial APs with an R/S ratio <1 (p<0.001) and negative delta wave in lead V1 (p<0.001). Epicardial inferior paraseptal APs were differentiated from endocardial APs by a negative delta wave in lead II (p=0.001), positive delta waves in AVR (p<0.001) and V1 (p=0.012), R/S ratio <1 in lead II (p=0.03), and R/S ratio ≥1 in V1 (p=0.04). Delta wave polarity and R/S ratio in lead V1 differentiate right endocardial inferior paraseptal APs from left endocardial APs. Delta wave polarities in leads II, AVR and V1, and R/S ratios in leads II and V1 estimate epicardial inferior paraseptal APs.
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Affiliation(s)
- Hasan Kutsi Kabul
- Department of Cardiology, Faculty of Medicine, Gulhane Military School, Ankara, Turkey
| | - Taner Ulus
- Department of Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
| | - Cem Barcın
- Department of Cardiology, Faculty of Medicine, Gulhane Military School, Ankara, Turkey
| | - Murat Unlu
- Department of Cardiology, Faculty of Medicine, Gulhane Military School, Ankara, Turkey
| | - Samed Samedli
- Department of Cardiology, Faculty of Medicine, Gulhane Military School, Ankara, Turkey
| | - Sedat Kose
- Department of Cardiology, Faculty of Medicine, Gulhane Military School, Ankara, Turkey
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Mao J, Moriarty JM, Mandapati R, Boyle NG, Shivkumar K, Vaseghi M. Catheter ablation of accessory pathways near the coronary sinus: value of defining coronary arterial anatomy. Heart Rhythm 2014; 12:508-514. [PMID: 25485779 DOI: 10.1016/j.hrthm.2014.11.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Accessory pathways can lie near or within the coronary sinus (CS). Radiofrequency catheter ablation of accessory pathways is a well-established treatment option, but this procedure can cause damage to adjacent coronary arteries. OBJECTIVE The purpose of this study was to evaluate the anatomic relationship between the coronary arteries and the CS. METHODS Retrospective data of patients who underwent catheter ablation of supraventricular tachycardia between June 2011 and August 2013 was reviewed. In addition, detailed analysis of coronary computed tomographic angiography (CTA) data from 50 patients was performed. RESULTS Between June 2011 and August 2013, 427 patients underwent catheter ablation of supraventricular tachycardia, of whom 105 (age 28 ± 17 years, 60% male) had accessory pathway-mediated tachycardia. Of these, 23 patients had accessory pathways near the CS, and 60% (N = 14) underwent concurrent coronary angiography. In 4 patients, the posterolateral (inferolateral) branch (PLA) of the right coronary artery was in close proximity to the CS, and 2 patients (18%) had stenosis of the PLA at the site of ablation. On CTA at their closest proximity, the PLA was 1.9 ± 1.3 mm and the left circumflex artery (LCx) was 2.0 ± 0.8 mm from the body of the CS, in right and left coronary artery-dominant patients, respectively. CS ostium and PLA were 3.6 ± 1.9 mm apart. In left-dominant patients, LCx and CS ostium were 3.8 ± 1.2 mm apart. CONCLUSION The PLA and LCx are in close proximity to the anteroinferior aspect of the CS ostium and proximal CS. The relationship of the CS and coronary arteries should be evaluated before ablation at these sites.
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Affiliation(s)
- Jessica Mao
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California
| | - John M Moriarty
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California
| | - Ravi Mandapati
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California; Loma Linda University Health Institute, Loma Linda, California
| | - Noel G Boyle
- Loma Linda University Health Institute, Loma Linda, California
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California.
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4
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Posteroseptal accessory pathway in association with coronary sinus diverticulum: electrocardiographic description and result of catheter ablation. J Interv Card Electrophysiol 2013; 38:43-9. [DOI: 10.1007/s10840-012-9775-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 12/26/2012] [Indexed: 10/27/2022]
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5
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Improvement in the quality of the cardiac vein images by optimizing the scan protocol of multidetector-row computed tomography. Heart Vessels 2009; 24:434-9. [DOI: 10.1007/s00380-008-1142-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2008] [Accepted: 12/19/2008] [Indexed: 10/20/2022]
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Pap R, Traykov VB, Makai A, Bencsik G, Forster T, Sághy L. Ablation of posteroseptal and left posterior accessory pathways guided by left atrium-coronary sinus musculature activation sequence. J Cardiovasc Electrophysiol 2008; 19:653-8. [PMID: 18284500 DOI: 10.1111/j.1540-8167.2008.01103.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION While some posteroseptal and left posterior accessory pathways (APs) can be ablated on the tricuspid annulus or within the coronary venous system, others require a left-sided approach. "Fragmented" or double potentials are frequently recorded in the coronary sinus (CS), with a smaller, blunt component from left atrial (LA) myocardium, and a larger, sharp signal from the CS musculature. METHODS AND RESULTS Forty patients with posteroseptal or left posterior AP were included. The LA-CS activation sequence was determined at the earliest site during retrograde AP conduction. Eleven APs (27.5%) were ablated on the tricuspid annulus (right endocardial), 9 (22.5%) inside the coronary venous system (epicardial), and 20 (50%) on the mitral annulus (left endocardial). A "fragmented" or double "atrial" potential was recorded in all patients inside the CS at the earliest site during retrograde AP conduction. Sharp potential from the CS preceded the LA blunt component (sharp/blunt sequence) in all patients with an epicardial AP, and in 10 of 11 (91%) patients with a right endocardial AP. Therefore, 18 of 19 (95%) APs ablated by a right-sided approach produced this pattern. The reverse sequence (blunt/sharp) was recorded in 19 of 20 (95%) patients with a left endocardial AP. CONCLUSION During retrograde AP conduction, the sequence of LA-CS musculature activation-as deduced from analysis of electrograms recorded at the earliest site inside the CS-can differentiate posteroseptal and left posterior APs that require left heart catheterization from those that can be eliminated by a totally venous approach.
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Affiliation(s)
- Róbert Pap
- 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary.
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Coronary Sinus Morphology in Patients with Posteroseptal Atrioventricular Accessory Pathways. J Arrhythm 2006. [DOI: 10.1016/s1880-4276(06)80012-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Mühlenbruch G, Koos R, Wildberger JE, Günther RW, Mahnken AH. Imaging of the Cardiac Venous System: Comparison of MDCT and Conventional Angiography. AJR Am J Roentgenol 2005; 185:1252-7. [PMID: 16247145 DOI: 10.2214/ajr.04.1231] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Diagnostic and therapeutic strategies in electrophysiology and interventional cardiology include the coronary venous system. The purpose of this study was to compare MDCT angiography with conventional coronary sinus angiography in terms of detailed anatomic display of the coronary veins. CONCLUSION MDCT angiography is a reliable alternative to conventional coronary sinus angiography for detailed anatomic display of the coronary veins.
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Affiliation(s)
- Georg Mühlenbruch
- Department of Diagnostic Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, Aachen 52057, Germany.
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Takenaka S, Yeh SJ, Wen MS, Yeh KH, Wang CC, Lin FC, Wu D. Characteristics and radiofrequency ablation in posteroseptal and left free-wall subepicardial accessory pathways. J Electrocardiol 2005; 38:69-76. [PMID: 15660351 DOI: 10.1016/j.jelectrocard.2004.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
UNLABELLED Accessory pathways (APs) that can only be ablated from the coronary sinus are likely to be located subepicardially. The electrocardiographic (ECG) and electrophysiological characteristics as well as the immediate radiofrequency ablation success rate and the recurrence rate were compared in 15 patients (11 posteroseptal and 4 left free-wall) with subepicardial APs and in 31 control patients with posteroseptal (15) and left free-wall (16) APs matched with age, sex, and AP location during the same study period in whom APs were successfully ablated from the endocardial approach. Patients with posteroseptal subepicardial APs had a longer tachycardia cycle length (355 +/- 32 vs 286 +/- 49 milliseconds, P < .05), a lower success rate (9 /11 vs 15/15, P = .09), and a higher recurrence rate (3/9 vs 0/15, P < .05) as compared with control patients. A negative delta wave with QS or QR pattern in lead II was present in all 4 patients with a manifest posteroseptal subepicardial AP located in the middle cardiac vein as compared with none of the 5 control patients with posteroseptal APs located in the proximal coronary sinus and 1 of the 9 control patients (P < .01). A positive delta wave in lead I along with an R/S of less than 1 in lead V 1 , and a negative delta wave in lead II, was noted in 1 of the 2 patients with left free-wall subepicardial APs and none of the 7 controls (P = .047). The local activation time is significantly shorter in the 4 patients with left free-wall subepicardial AP than in the 16 control patients (31 +/- 9 vs 89 +/- milliseconds, P = .044). CONCLUSIONS Some ECG characteristics are suggestive of APs located in the middle cardiac vein and left free-wall subepicardial site, while a longer local activation time is characteristic of left free-wall APs. The success rate is lower and the recurrence rate higher with radiofrequency ablation in patients with subepicardial AP.
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Affiliation(s)
- Sou Takenaka
- Second Section of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 105 Taipei, Taiwan
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Manita M, Kaneko Y, Kurabayashi M, Yeh SJ, Wen MS, Wang CC, Lin FC, Wu D. Electrophysiological characteristics and radiofrequency ablation of accessory pathways with slow conductive properties. Circ J 2004; 68:1152-9. [PMID: 15564699 DOI: 10.1253/circj.68.1152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Atrioventricular accessory pathways (AP) with unusually long ventriculo-atrial (VA) conduction times are present in a significant subset of patients with the Wolff-Parkinson-White (WPW) syndrome, not including patients with the permanent form of atrioventricular junctional reciprocating tachycardia. METHODS AND RESULTS We compared the electrophysiological characteristics and outcomes after radiofrequency (RF) ablation in 34 patients with the WPW syndrome, a VA interval >80 ms, and paroxysmal tachycardia with an RP/PR ratio <1 (the slow group), vs 80 patients with WPW syndrome and a VA interval <80 ms (the fast group). AP were found in the posteroseptal region significantly more often in the slow than in the fast group. In addition, the decremental conductive properties of the AP were more common in the slow than in the fast group. Catheter ablation of AP was highly successful in both groups, although ablation required a greater number of RF applications and longer procedure times in the slow group, especially for AP with decremental conductive properties. CONCLUSIONS A posteroseptal AP location was more common in AP associated with long conduction times than in AP with typical conductive properties. Both types of AP were successfully ablated, although the slow group required longer procedures and more RF energy deliveries.
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Affiliation(s)
- Mamoru Manita
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma, Japan.
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Takenaka S, Yeh SJ, Wen MS, Yeh KH, Wang CC, Lin FC, Wu D. Algorithm for differentiation of left and right posterior paraseptal accessory pathway. J Electrocardiol 2004; 37:75-81. [PMID: 15127372 DOI: 10.1016/j.jelectrocard.2004.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We studied 196 consecutive patients with posterior paraseptal accessory pathway (AP); 124 showed manifest preexcitation and 72 were concealed AP. Successful ablation was obtained from left-sided approach in 134 patients (left posterior pasaseptal [LPS] group) and from right sided approach in 62 patients (right posterior paraseptal [RPS] group). A ventriculo-atrial (VA) interval of <50 ms recorded at LPS region (VA(LPS)) during right ventricular pacing identified 95 of the 134 patients (71%) with LPS AP with 100% specificity and positive predictive value. In the 101 patients with VA(LPS) >/=50 ms, a difference in VA interval of <20 ms recorded at the His bundle region and LPS region, DeltaVA(H-LPS), during right ventricular pacing predicted RPS AP with a sensitivity of 97%, a specificity of 85% and a positive predictive value of 91%. When these 2 parameters were used together for prediction of LPS or RPS AP, the sensitivity, specificity, and positive predictive value were 96%, 97%, and 98% for LPS AP, and 97%, 96%, and 91% for RPS AP, respectively. This simple new algorithm using VA(LPS) and DeltaVA (H-LPS) during right ventricular pacing successfully discriminates LPS and RPS AP with high sensitivity, specificity, and positive predictive value and could facilitate radiofrequency ablation in patients with posterior paraseptal AP.
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Affiliation(s)
- So Takenaka
- Hiroshima University Graduate School of Biomedical Sciences Hiroshima, Japan
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Gatzoulis KA, Apostolopoulos T, Costeas X, Zervopoulos G, Papafanis F, Sotiropoulos H, Gialafos J, Toutouzas P. Radiofrequency catheter ablation of posteroseptal accessory pathways--results of a step-by-step ablation approach. J Interv Card Electrophysiol 2001; 5:193-201. [PMID: 11342758 DOI: 10.1023/a:1011489710747] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Transcatheter radiofrequency ablation of posteroseptal accessory pathways (AP) is challenging. A number of different interventional approaches have been suggested by different groups. The selection of the initial approach is crucial in order to reduce radiation exposure and the number of unsuccessful lesions applied. We present our ablation technique as guided by a simplified electrocardiographic analysis of the delta wave polarity and the electrophysiologic mapping results. METHODS AND RESULTS Out of 35 manifest APs encountered in the right (n=17) or the left posteroseptum (n=18) in 35 patients, 34 were successfully ablated. Despite their left sided location, 7 of the 18 "left" sided APs were ablated after switching from an initial arterial to a venous approach looking for an appropriate target site in the right posteroseptal space or within the coronary sinus network. The other 11 left sided APs were ablated in the mitral ring, on 2 occasions, on their atrial aspect through a retrograde transmitral approach. On the contrary, 16 of the 17 "right" sided APs were successfully ablated exclusively through a venous approach. Fourteen of these were ablated in the right posteroseptum, in 2 cases, only after reaching their ventricular aspect. Two right sided APs were interrupted in the coronary sinus os and the middle cardiac vein respectively. CONCLUSION It appears that even though the electrocardiographic and electrophysiologic location of the AP in the posteroseptal space helps select the appropriate initial approach, it does not always guarantee a successful ablation procedure in the expected site of the corresponding atrioventricular ring. Not uncommonly, it will be necessary to look after intermediate target sites within the coronary sinus to improve the overall ablation success rate.
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Affiliation(s)
- K A Gatzoulis
- University and State Cardiac Departments, Hippokration General Hospital, Athens, Greece
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Echeverría IJ, Merino JL, Peinado R, Ramírez L, Peinado A, Sobrino JA. [Cardioinhibitory vagal response not related to pain, and induced by radiofrequency application during ablation of right posteroseptal accessory pathway]. Rev Esp Cardiol 2000; 53:1399-402. [PMID: 11060260 DOI: 10.1016/s0300-8932(00)75248-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Inappropriate sinus tachycardia is the most common arrhythmia induced by radiofrequency energy delivery in the posteroseptal area. It has been suggested that this could be secondary to parasymphathetic nerve injury. We report a patient with extreme sinus bradycardia and PR interval prolongation induced by radiofrequency energy delivered in the coronary sinus ostium area, but not related to any other stimulus. The most probable mechanism of the disorder was transient stimulation of the vagal afferent nerve fibers located in this anatomical area.
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Affiliation(s)
- I J Echeverría
- Laboratorio de Electrofisiología. UMQ de Cardiología. Hospital General Universitario La Paz. Madrid.
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Hina K, Murakami T, Kusachi S, Hirami R, Matano S, Ohnishi N, Iwasaki K, Kita T, Sakakibara N, Tsuji T. Decreased amplitude of left ventricular posterior wall motion with notch movement to determine the left posterior septal accessory pathway in Wolff-Parkinson-White syndrome. Heart 1999; 82:731-9. [PMID: 10573503 PMCID: PMC1729197 DOI: 10.1136/hrt.82.6.731] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine preoperatively, by analysing asynchronous left ventricular wall motion, whether to approach through the right ventricle or the left ventricle when carrying out catheter ablation of the accessory pathway in Wolff-Parkinson-White syndrome, especially in patients with the pathway located on the septum. METHODS 73 patients with manifest Wolff-Parkinson-White syndrome who underwent successful catheter ablation were studied. Location of accessory pathway was classified as right ventricular side: right anterior paraseptum, right anterior, right lateral, right posterior, anterior septum, midseptum, right posterior septum; left ventricular side: left posterior septum, left posterior, left lateral, left anterior. Asynchronous systolic wall motion was analysed by cross sectional echocardiography. RESULTS Echocardiography showed that the amplitude of left ventricular posterior systolic wall motion was reduced when the pathway was located on the left ventricular side as opposed to the right ventricular side (mean (SD), 11.1 (1.7) v 12.9 (1.1) mm, p < 0.001), especially in patients with left posterior septal accessory pathway (9.7 (0.8) mm). There were no overlapping values between the left posterior septal accessory pathway and the right ventricular side accessory pathway. Posterior wall notch motion was observed in all patients with a left posterior septal accessory pathway (9/9), but not at all in patients with pathways located on the right ventricular side of the septum. In patients with a septal accessory pathway, an ECG algorithm provided poor information (relatively low sensitivity, specificity, and predictive value) for determining whether the subsite faced either the left (left posterior septum) or the right ventricle (anterior septum, midseptum, right posterior septum). CONCLUSIONS Decreased amplitude of left ventricular posterior wall motion with notch movement is an important finding for accessory pathways located on the left posterior septum. These findings provided clinically useful information for determining whether to approach catheter ablation from the right or the left ventricle.
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Affiliation(s)
- K Hina
- Cardiovascular Center, Sakakibara Hospital, Okayama, Japan
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Tai CT, Chen SA, Chiang CE, Chang MS. Characteristics and radiofrequency catheter ablation of septal accessory atrioventricular pathways. Pacing Clin Electrophysiol 1999; 22:500-11. [PMID: 10192859 DOI: 10.1111/j.1540-8159.1999.tb00478.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Septal accessory AV pathways are located in the complex AV septal space that also contains the specialized conduction system. They have unique electrocardiographical and electrophysiological characteristics to be differentiated from free-wall accessory pathways. Some of the septal pathways have AV nodelike conduction properties and produce a similar activation sequence in the retrograde conduction. Several methods have been developed to distinguish them from AV nodal pathways. Radiofrequency catheter ablation using the titration method and endocardial approach without entrance into the coronary sinus is effective in eliminating most of the septal accessory pathways without impairment of AV conduction. However, some posteroseptal accessory pathways may require energy application inside the coronary sinus, thus information of the coronary sinus anatomy is important for preventing complication.
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Affiliation(s)
- C T Tai
- Department of Medicine, National Yang-Ming University, School of Medicine, Taiwan, R.O.C
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Inama G, Vergara G, Gramegna L, Rillo M, Fuochi C, Furlanello F. Catheter ablation of Wolff-Parkinson-White syndrome associated with congenital absence of inferior vena cava. J Interv Card Electrophysiol 1998; 2:301-4. [PMID: 9870026 DOI: 10.1023/a:1009753424261] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In the present report we describe a patient (a 36-year-old woman with 15 year history of supraventricular tachyarrhythmias) with congenital absence of inferior vena cava (IVC) revealed during radiofrequency (RF) catheter ablation procedure for right postero-septal Wolff-Parkinson-White syndrome (WPW). For the absence of IVC, the ablation procedure was more difficult, because we had to perform the ablation with the catheters (the ablator catheter and the coronary sinus catheter) introduced both through the superior vena cava. The application of RF energy (35 Watt for 60 seconds) at successful site abolished accessory pathway conduction. The following day was performed the venous angiography, showing the absence of the IVC and a venous return via paravertebral venous plexus to the azygous vein and superior vena cava into the right atrium. Computer tomography confirmed the absence of the IVC with azygous continuation. The drainage via the azygous system modified the radiological image on chest roentgenogram of the right mediastinal silhouette. During cardiogenesis fusion of the IVC and organisation of the heart occur between the 33rd to 40th embryonic days. It is therefore possible that some unknown teratogenic mechanism at this critical period might have caused, in the patient, both the developmental arrest of IVC and failure of regression of atrio-ventricular anatomical and electrical continuity in the right postero-septal region.
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Affiliation(s)
- G Inama
- Division of Cardiology, S. Chiara Hospital, Trento, Italy
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