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Titolo:
LOCALIZATION AND RADIOFREQUENCY CATHETER ABLATION OF LEFT-SIDED ACCESSORY PATHWAYS DURING ATRIAL-FIBRILLATION - FEASIBILITY AND ELECTROGRAMCRITERIA FOR IDENTIFICATION OF APPROPRIATE TARGET SITES
Autore:
HINDRICKS G; KOTTKAMP H; CHEN X; WILLEMS S; HAVERKAMP W; SHENASA M; BREITHARDT G; BORGGREFE M;
Indirizzi:
UNIV MUNSTER,INNERE MED KLIN C,ALBERT SCHWEITZER STR 33 D-48129 MUNSTER GERMANY HOSP UNIV MUNSTER,DEPT CARDIOL & ANGIOL MUNSTER GERMANY INST ARTERIOSCLEROSIS RES MUNSTER GERMANY
Titolo Testata:
Journal of the American College of Cardiology
fascicolo: 2, volume: 25, anno: 1995,
pagine: 444 - 451
SICI:
0735-1097(1995)25:2<444:LARCAO>2.0.ZU;2-4
Fonte:
ISI
Lingua:
ENG
Soggetto:
PARKINSON-WHITE SYNDROME; ATRIOVENTRICULAR PATHWAY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
13
Recensione:
Indirizzi per estratti:
Citazione:
G. Hindricks et al., "LOCALIZATION AND RADIOFREQUENCY CATHETER ABLATION OF LEFT-SIDED ACCESSORY PATHWAYS DURING ATRIAL-FIBRILLATION - FEASIBILITY AND ELECTROGRAMCRITERIA FOR IDENTIFICATION OF APPROPRIATE TARGET SITES", Journal of the American College of Cardiology, 25(2), 1995, pp. 444-451

Abstract

Objectives. The purpose of the present study was to assess the feasibility of and electrophysiologic criteria for successful radio-frequency catheter ablation of left sided accessory pathways during atrial fibrillation in patients with Wolf-Parkinson-White syndrome. Background. The onset of recurrent or sustained atrial fibrillation can complicateor significantly prolong accessory pathway catheter ablation procedures. Methods. We studied 19 consecutive patients (mean age [+/-SD] 44 +/- 16 years) with Wolff-Parkinson-White syndrome who had ongoing atrial fibrillation with rapid anterograde conduction over the accessory pathway (mean ventricular rate [+/-SD] 173 +/- 26 heats/min, range 130 to 220) at the beginning of the localization procedure during radiofrequency catheter ablation. Localization and ablation of the accessory pathway were performed with a 7F deflectable catheter (4-mm tip) that was placed underneath the mitral valve annulus. The electrophysiologic criteria from unipolar and bipolar local electrograms were compared forsuccessful (n = 18) and unsuccessful (n = 39) sites. Results. The accessory pathways were localized in the left posteroseptal (n = 6), posterior (n = 1), posterolateral (n = 7) and lateral (n = 5) regions and successfully ablated during atrial fibrillation in 18 (95%) of 19 patients with a mean of 3 +/- 2 radiofrequency pulses (range 1 to 8, median 2). Presence of an accessory pathway potential (94% vs. 44%), early activation time of the ventricular electrogram (-3.2 +/- 9.2 vs. -15.3+/- 12.6 ms) and recording of atrial activation (88% vs. 61%) from the ablation catheter were helpful in identifying successful sites (p < 0.001, p < 0.001 and p < 0.05, respectively, compared with unsuccessful sites). In addition, the, ventricular activation time in relation tothe intrinsic deflection of the unipolar electrogram was significantly earlier at successful than unsuccessful sites (18.1 +/- 4.8 vs. 24.4+/- 6.6 ms, p < 0.01). A QS complex on the unipolar electrogram was observed at 96% of successful sites and at 94% of unsuccessful sites (p= 0.74). Multivariate logistic regression analysis revealed that the presence of an accessory pathway potential (p < 0.002) and early ventricular activation time in relation to the onset of the QRS complex (p < 0.001) were independent predictors of ablation success. Conclusions. Localization and radiofrequency catheter ablation of left-sided accessory pathways is possible in patients with sustained atrial fibrillation and rapid anterograde conduction over the accessory pathway during the ablation procedure. The electrophysiologic criteria described herecan be used to reliably identify successful sites for radiofrequency ablation.

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Documento generato il 30/09/20 alle ore 12:11:12