title: Paraseptal accessory pathway in Wolff-Parkinson- White-Syndrom: ablation from the right, from the left or within the coronary sinus/middle cardiac vein?
abstract: 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.
authors.affiliation: Department of Electrophysiology, University of Leipzig, Heart Center, Cardiology, Leipzig, Germany. kobza@freesurf.ch
authors.forename: Richard
authors.initials: R
authors.lastname: Kobza
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
authors.forename: Hildegard
authors.initials: H
authors.lastname: Tanner
authors.forename: Christopher
authors.initials: C
authors.lastname: Piorkowski
authors.forename: Ulrike
authors.initials: U
authors.lastname: Wetzel
authors.forename: Petra
authors.initials: P
authors.lastname: Schirdewahn
authors.forename: Anja
authors.initials: A
authors.lastname: Dorszewski
authors.forename: Jin-Hong
authors.initials: JH
authors.lastname: Gerds-Li
authors.forename: Hans
authors.initials: H
authors.lastname: Kottkamp
mesh_terms: 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*
references.citation: N Engl J Med. 1991 Jun 6;324(23):1612-8
references.pmid: 2030717
references.citation: J Cardiovasc Electrophysiol. 2002 Dec;13(12):1222-6
references.pmid: 12521337
references.citation: J Cardiovasc Electrophysiol. 1998 Oct;9(10):1015-25
references.pmid: 9817553
references.citation: N Engl J Med. 1999 Feb 18;340(7):534-44
references.pmid: 10021475
references.citation: Anat Rec. 2000 Sep 1;260(1):81-91
references.pmid: 10967539
references.citation: J Am Coll Cardiol. 1994 Jan;23(1):107-16
references.pmid: 8277067
references.citation: Circulation. 2000 Feb 15;101(6):647-52
references.pmid: 10673257
references.citation: Circulation. 2002 Sep 10;106(11):1362-7
references.pmid: 12221053
references.citation: J Am Coll Cardiol. 1994 Dec;24(7):1725-31
references.pmid: 7963120
references.citation: J Cardiovasc Electrophysiol. 1998 Jan;9(1):2-12
references.pmid: 9475572
references.citation: J Cardiovasc Electrophysiol. 2001 Feb;12(2):210-7
references.pmid: 11232621
references.citation: Eur Heart J. 1999 Aug;20(15):1068-75
references.pmid: 10413636