Catheter ablation of the atrioventricular junction with DC energy carries a significant, previously unrecognized risk of death (5.1%), particularly from lethal arrhythmias, when applied to patients with severe left ventricular dysfunction. Great care should be taken in these seriously ill patients to guard against postablation ventricular arrhythmias.
Using quantitative two-dimensional echocardiography, we found that most previously reported ECG criteria for right atrial enlargement have low predictive power. The best predictors of right atrial enlargement were a P wave height > 1.5 mm in lead V2 and, as new criteria, a QRS axis > 90 degrees and an R/S ratio > 1 in lead V1 in the absence of complete right bundle branch block. The combined sensitivity of these three criteria was 49%, with preservation of 100% specificity. Further studies are needed to prospectively validate these findings.
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