Algorithm for differentiation of left and right posterior paraseptal accessory pathway

So Takenaka, San Jou Yeh, Ming Shien Wen, Kuan Hung Yeh, Chun Chieh Wang, Fun Chung Lin, Delon Wu*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

4 Scopus citations

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 ventriculoatrial (VA) interval of <50 ms recorded at LPS region (VALPS) 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, ΔVA(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 VALps and ΔVA (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.

Original languageEnglish
Pages (from-to)75-81
Number of pages7
JournalJournal of Electrocardiology
Volume37
Issue number2
DOIs
StatePublished - 04 2004

Keywords

  • Ablation
  • Electrophysiology
  • Supraventricular tachycardia

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