Algorithm for differentiation of left and right posterior paraseptal accessory pathway.
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.
Takenaka
So
S
Hiroshima University Graduate School of Biomedical Sciences Hiroshima, Japan.
Yeh
San-Jou
SJ
Wen
Ming-Shien
MS
Yeh
Kuan-Hung
KH
Wang
Chun-Chieh
CC
Lin
Fun-Chung
FC
Wu
Delon
D
D000465:Algorithms; D017115:Catheter Ablation; D003937:Diagnosis, Differential; D004594:Electrophysiology; D005260:Female; D006329:Heart Conduction System / Q000002:abnormalities*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013617:Tachycardia, Supraventricular / Q000175:diagnosis