Atrial pacing at multiple sites in the Wolff-Parkinson-White syndrome.

Abstract

Atrial pacing at multiple sites was used in an attempt to predict the site of pre-excitation in 5 patients with Wolff-Parkinson-White syndrome with 5 different anomalous pathway locations (right anterior, right posterior, septal, left posterior, and left lateral). At least 3 atrial pacing sites were tested in each patient. Pacing sites tested included high right atrium, low lateral right atrium, low septal right atrium, proximal coronary sinus, and distal coronary sinus. Atrial stimulation sites with shortest and longest stimulus-delta intervals could be identified in each patient, the shortest stimulus-delta interval in each case ranging from 60 to 80 ms. The difference between the shortest and longest stimulus-delta interval in each case ranged from 60 to 110 ms. It was suggested that the site with the shortest stimulus-delta interval corresponded to a site close to the atrial insertion of the anomalous pathway. This hypothesis was confirmed in all cases (3 with epicardial mappitng and 2 with retrograde atrial activation data). In conclusion, atrial pacing at multiple sites is helpful in predicting the site of anterogradely conducting anomalous pathways, and appears particularly usefulfor differentiation of right posterior, left posterior, and septal pre-excitation.

Patterns of atrial activation during right ventricular pacing in patients with concealed left-sided Kent pathways.

“…1 D. E. Ward, A. J7. Camm, and R. A. J. Spurrell conduction in the accessory pathway was excluded by the lack of pre-excitation in response to atrial stimulation near the accessory pathway (Boineau et al, 1973;Denes et al, 1977) and in 7 patients by the absence of pre-excitation during atrial fibrillation. Retrograde conduction curves were obtained by plotting the values of V-LA and V-RA and the corresponding intervals between successive atrial electrograms in response to the premature stimulus V2 against the coupling interval V1-V2 of the extrastimulus.…”

Mapping und Ablation bei Präexzitationssyndromen

“…4). Erfolgt an dieser Stelle eine Stimulation, entsteht die maximale Präexzitation mit einem sehr kurzen Stimulus-δ-Intervall [13]. Abgabe von Hochfrequenzstrom in dieser Position unterbindet die Überleitung über die Bahn, sichtbar am Verlust der Präexzitation innerhalb weniger Sekunden (<10 s).…”

Pre- and Intraoperative Identification of Multiple Accessory Pathways

“…The methods used to localize the bypass tracts were: ( I) assessment of the atrial activation sequence during orthodromic tachycardia and during right ven tricular incremental stimulation [5,6], as well as dur ing the delivery of premature right ventricular beats during orthodromic tachycardia [7]; (2) analysis of delta wave morphology during incremental atrial stimulation [5], and (3) measurement of the stimulus to delta wave interval during atrial stimulation [8]. The last method could not be completed in case 3 owing to induced orthodromic tachycardia at every attempt at atrial stimulation.…”