Sites of conduction block in accessory atrioventricular pathways. Basis for concealed accessory pathways.

Kück, Karl‐Heinz; Friday, Karen J.; Kunze, K.; Schlüter, Michael; Lazzara, Ralph; Jackman, Warren M.

doi:10.1161/01.cir.82.2.407

Cited by 91 publications

(18 citation statements)

References 41 publications

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“…Usually anterograde conduction through an accessory pathway produces full pre-excitation, resulting in the formation of a typical delta wave, as in manifest WPW syndrome. However, there must be a decremental property in the preexcited area of the ventricular muscle in concealed WPW syndrome, as suggested by Kuck et al 9 and Gonzales et al 10 Our results also suggest the possibility of this characteristic, because of the similarity to intermittent WPW syndrome where anterograde conduction activity must surely be taking place through the accessory pathways, but is sometimes blocked or somehow disappears on the way to the ventricle.…”

Section: Concealed Anterograde Conduction Through An Accessory Pathwaysupporting

confidence: 78%

Non-Invasive Diagnosis of Concealed Wolff-Parkinson-White Syndrome by Detection of Concealed Anterograde Pre-Excitation.

et al. 2001

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Section: Concealed Anterograde Conduction Through An Accessory Pathwaysupporting

confidence: 78%

Non-Invasive Diagnosis of Concealed Wolff-Parkinson-White Syndrome by Detection of Concealed Anterograde Pre-Excitation.

et al. 2001

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“…Thus, the catheter was positioned at the site of the atrial insertion of the accessory pathway in all patients. 16 Of note is that in three patients, multiple accessory pathway potentials could be recorded through the same catheter electrode, suggesting a pathway diverging into multiple strands. Another plausible explanation may be the oblique course of midseptal pathways on the right atrial septal surface, which makes them more parallel with the ablation catheter.…”

Section: Catheter Ablation Of Midseptal Pathwaysmentioning

confidence: 88%

“…During a follow-up period of 16 sociated with a risk of producing right bundle branch block yet has a lower incidence than was observed using a ventricular approach.14…”

Section: Follow-upmentioning

confidence: 96%

Preservation of atrioventricular nodal conduction during radiofrequency current catheter ablation of midseptal accessory pathways.

1992

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BACKGROUND Septal accessory atrioventricular (AV) pathways may be located in close vicinity of the His bundle-AV nodal conduction system. Attempts at surgical or electrical interruption of these pathways may therefore result in impairment of normal AV conduction. This study focuses on a subset of septal pathways with an atrial insertion located inside the triangle of Koch. In this study, they were called "midseptal." METHODS AND RESULTS Six patients with a midseptal accessory pathway (mean +/- SD age, 40 +/- 12 years; five with Wolff-Parkinson-White syndrome and one with a concealed accessory pathway) underwent attempts at ablation of their pathway using 500-kHz radiofrequency current applied to the atrial insertion of the accessory connection. Guided by the recording of accessory pathway activation potentials, the ablation catheter was positioned in all patients in an area bounded anteriorly by the tip electrode of the His bundle catheter and posteriorly by the coronary sinus ostium. All pathways were successfully ablated without the induction of complete heart block. First-degree AV conduction block occurred in one patient in whom a concealed accessory connection was located closer to the AV node than to the coronary sinus ostium. CONCLUSIONS Radiofrequency current catheter ablation may be used effectively for midseptal accessory pathways and should be preferred in experienced centers as a safe alternative to surgical therapy.

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“…Thus, left-sided accessory AV path ways usually follow an epicardial and the right-sided ones a subendocardial course. Second, the mitral annulus usually is an intact, fibrotic or even calcified AV barrier, whereas the tricuspid annulus is öfter incompletely devel oped and with multiple defects [16], Subsequently, the atrial or ventricular insertion sites of left-sided accessory AV pathways, and the annular portion of the right-sided accessory AV pathways may well be recognized as the rea sonable weakpoint for intracardially approached catheter ablation [13,17,18].…”

Section: Main Findingsmentioning

confidence: 99%

Value of Local Electrogram Characteristics Predicting Successful Catheter Ablation of Left- versus Right-Sided Accessory Atrioventricular Pathways by Radiofrequency Current

et al. 1995

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Despite similar guidance by local electrogram criteria, catheter ablation of right-sided accessory atrioventricular (AV) pathways by radiofrequency current has been less effective than that of left-sided ones. In order to elucidate the possible diversities in local electrosignal criteria, we systematically analyzed the morphological and timing characteristics of 215 bipolar local electrograms from catheter ablation sites of 65 left-sided accessory AV pathways and of 356 from those of 37 right-sided ones in 92 consecutive patients with Wolff-Parkinson-White syndrome or AV reentrant tachycardia incorporating concealed accessory AV pathways. After stepwise multivariate analysis, we selected the presence of a possible accessory pathway potential, local ventricular activation preceding QRS complex for 20 ms or more during ventricular insertion mapping, and the local retrograde ventriculoatrial (VA) continuity, local retrograde VA interval ≤ 50 ms, electrogram stability (left-sided targets only), retrograde accessory pathway potential (right-sided targets only) during atrial insertion mapping, as independent local electrogram predictors for successful ablation of left- and right-sided accessory AV pathways. Combination of all local electrogram predictors could have moderate chance of success (80 and 51 %) for the ventricular and atrial insertion ablation of left-sided accessory AV pathways, but only low probability of success (40% in ventricular insertion ablation) or very low sensitivity (12.5% in atrial insertion ablation) for right-sided ones. In conclusion, with the present approach, successful catheter ablation of right-sided accessory AV pathways, compared to left-sided ones, still necessitate a breakthrough in the precision mapping and the efficiency of energy delivery.

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Sites of conduction block in accessory atrioventricular pathways. Basis for concealed accessory pathways.

Cited by 91 publications

References 41 publications

Non-Invasive Diagnosis of Concealed Wolff-Parkinson-White Syndrome by Detection of Concealed Anterograde Pre-Excitation.

Non-Invasive Diagnosis of Concealed Wolff-Parkinson-White Syndrome by Detection of Concealed Anterograde Pre-Excitation.

Preservation of atrioventricular nodal conduction during radiofrequency current catheter ablation of midseptal accessory pathways.

Value of Local Electrogram Characteristics Predicting Successful Catheter Ablation of Left- versus Right-Sided Accessory Atrioventricular Pathways by Radiofrequency Current

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