Electrocardiographic and electrophysiologic characteristics of anteroseptal, midseptal, and posteroseptal accessory pathways

Haghjoo, M. and Kharazi, A. and Fazelifar, A.F. and Alizadeh, A. and Emkanjoo, Z. and Sadr-Ameli, M.A. (2007) Electrocardiographic and electrophysiologic characteristics of anteroseptal, midseptal, and posteroseptal accessory pathways. Heart Rhythm, 4 (11). pp. 1411-1419.


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Background: Approximately 30 of all accessory pathways (APs) are located in the septal area, and understanding the electrocardiographic and electrophysiologic of these APs is crucial for safe and effective ablation of these pathways. Objective: In this study, the electrocardiographic and electrophysiologic characteristics of anteroseptal, midseptal, and posteroseptal APs were investigated in detail to elucidate unique electrical properties of APs in each location. Methods: From April 2002 to October 2006, a total of 120 patients with a septal AP-mediated tachycardia were enrolled in the study. A detailed examination including electrocardiographic analysis and electrophysiologic study was performed in all patients. Results: A total of 120 patients, including 98 patients with posteroseptal APs, 14 patients with anteroseptal APs, and 8 patients with midseptal APs, were studied. The anteroseptal APs could be differentiated from the midseptal APs by the 2 or more positive delta waves in inferior leads, whereas there is significant overlap in electrocardiographic features of midseptal and posteroseptal APs. The mean tachycardia cycle length was significantly shorter in patients with midseptal AP compared with those with anteroseptal and posteroseptal APs (284 ± 49 ms vs 342 ± 46 ms vs 350 ± 68 ms, P = .03). The AH interval during tachycardia was also shorter in patients with midseptal APs (149 ± 16 ms vs 200 ± 51 ms vs 168 ± 48 ms, P = .04). The patients with posteroseptal AP had a significantly higher incidence of atrial fibrillation (35) than those with either midseptal (12) or anteroseptal (14) APs (P = .04). The patients with posteroseptal APs also had a significantly shorter antegrade effective refractory period of the AP (276 ± 54 ms) than those with either midseptal (313 ± 71 ms) or anteroseptal (325 ± 61) APs (P = .036). Conclusion: Electrocardiographic analysis is a reliable method for differentiation of the anteroseptal from the midseptal APs, whereas the same is not true for the midseptal and posteroseptal APs. Midseptal APs were characterized by faster orthodromic tachycardia, whereas posteroseptal APs had a higher inducibility of atrial fibrillation. © 2007 Heart Rhythm Society.

Item Type: Article
Additional Information: cited By 8
Uncontrolled Keywords: adolescent; adult; aged; article; catheter ablation; controlled study; delta rhythm; differential diagnosis; electrocardiography; female; follow up; heart accessory conduction pathway; heart atrium fibrillation; heart electrophysiology; heart muscle refractory period; heart ventricle septum; human; major clinical study; male; priority journal; radiofrequency ablation; reliability; sensitivity and specificity; tachycardia, Adult; Atrial Fibrillation; Atrioventricular Node; Catheter Ablation; Electrocardiography; Electrophysiologic Techniques, Cardiac; Electrophysiology; Female; Heart Atria; Heart Conduction System; Heart Septum; Humans; Male; Retrospective Studies; Risk Factors; Tachycardia; Treatment Outcome
Subjects: WG Cardiovascular System
Divisions: School of Rehabilitation Sciences
Depositing User: parto mrs bakhtminoo
Date Deposited: 26 Feb 2019 08:41
Last Modified: 26 Feb 2019 08:41
URI: http://eprints.iums.ac.ir/id/eprint/9983

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