title: Algorithm for differentiation of left and right posterior paraseptal accessory pathway.
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.
authors.affiliation: Hiroshima University Graduate School of Biomedical Sciences Hiroshima, Japan.
authors.forename: So
authors.initials: S
authors.lastname: Takenaka
authors.forename: San-Jou
authors.initials: SJ
authors.lastname: Yeh
authors.forename: Ming-Shien
authors.initials: MS
authors.lastname: Wen
authors.forename: Kuan-Hung
authors.initials: KH
authors.lastname: Yeh
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Wang
authors.forename: Fun-Chung
authors.initials: FC
authors.lastname: Lin
authors.forename: Delon
authors.initials: D
authors.lastname: Wu
mesh_terms: 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