Paraseptal accessory pathway in Wolff-Parkinson- White-Syndrom: ablation from the right, from the left or within the coronary sinus/middle cardiac vein?
OBJECTIVE
In 1999 the consensus statement "living anatomy of the atrioventricular junctions" was published. With that new nomenclature the former posteroseptal accessory pathway (APs) are termed paraseptal APs. The aim of this study was to identify ECG features of manifest APs located in this complex paraseptal space.


RESULTS
ECG characteristics of all patients who underwent radiofrequency ablation of an AP during a 3 year period were analyzed. Of the 239 patients with one or more APs, 30 patients had a paraseptal AP with preexcitation. Compared to APs within the coronary sinus (CS) or the middle cardiac vein (MCV) the right sided paraseptal APs significantly more often showed an isoelectric delta wave in lead II and/or a negative delta wave in aVR. The left sided paraseptal APs presented a negative delta wave in II significantly more often compared to the right sided APs.


CONCLUSIONS
According to the site of radiofrequency ablation, paraseptal APs are classified into 4 subgroups: paraseptal right, paraseptal left, inside the CS or inside the MCV. Subtle differences in preexcitation patterns of the delta wave as well as of the QRS complex exist. However, the definitive localization of APs remains reserved to the periinterventional intracardiac electrogram analysis.
Kobza
Richard
R
Department of Electrophysiology, University of Leipzig, Heart Center, Cardiology, Leipzig, Germany. kobza@freesurf.ch
Hindricks
Gerhard
G
Tanner
Hildegard
H
Piorkowski
Christopher
C
Wetzel
Ulrike
U
Schirdewahn
Petra
P
Dorszewski
Anja
A
Gerds-Li
Jin-Hong
JH
Kottkamp
Hans
H
D000328:Adult; D000704:Analysis of Variance; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000002:abnormalities / Q000503:physiopathology* / Q000601:surgery; D006346:Heart Septum / Q000294:innervation* / Q000601:surgery; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D014927:Wolff-Parkinson-White Syndrome / Q000601:surgery*
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