Comparison of local electrogram predictors for successful catheter ablation of left-versus right-sided accessory atrioventricular pathways by radiofrequency current

Jiunn Lee Lin, Wen Jone Chen, Jen Tsong Schie, Chuen Den Tseng, Jin Jer Chen, Yun Zu Tseng, Wen Pin Lien

Research output: Contribution to journalArticle

Abstract

Analysis of local electrogram manifestations is critical to the success of radiofrequency catheter ablation of accessory atrioventricular (AV) pathways. However, despite similar criteria, the ablation of right-sided targets has been less effective than that of left-sided ones. In order to elucidate the possible variations, we systematically analyzed the morphological and timing characteristics of 215 bipolar local electrograms from ablation sites of 65 left-sided accessory AV pathways, and 356 from those of 37 right-sided ones in 92 consecutive patients. By multivariate analysis, we selected the presence of a possible accessory pathway potential, local ventricular activation preceding QRS complex for 20 ms or more (ventricular insertion mapping); and the local retrograde ventriculoatrial continuity, local retrograde ventriculo-atrial interval ≤50 ms (atrial insertion mapping) as the common independent outcome predictors by local electrogram criteria for ablation of left- and right-sided accessory AV pathways. Electrogram stability for left-sided targets and retrograde accessory pathway potential for right-sided ones were additional indicators during atrial insertion ablation. Combination of all local electrogram predictors could have moderate chance of success for ablation of left-sided accessory AV pathways: positive predictive value of 80% and 51% by ventricular and atrial insertion mapping. However, such combination had either low positive predictive value or very low sensitivity in cases of right-sided accessory AV pathways. In conclusion, successful catheter ablation of right-sided accessory AV pathways, as comparing to left-sided ones, necessitated still more breakthrough in addition to local signal analysis.

Original languageEnglish
Pages (from-to)47-58
Number of pages12
JournalBiomedical Engineering - Applications, Basis and Communications
Volume6
Issue number1
Publication statusPublished - Feb 1 1994
Externally publishedYes

Fingerprint

Accessory Atrioventricular Bundle
Catheter Ablation
Catheters
Accessories
Ablation
Signal analysis
Multivariate Analysis
Chemical activation

ASJC Scopus subject areas

  • Biophysics
  • Bioengineering
  • Biomedical Engineering

Cite this

Comparison of local electrogram predictors for successful catheter ablation of left-versus right-sided accessory atrioventricular pathways by radiofrequency current. / Lin, Jiunn Lee; Chen, Wen Jone; Schie, Jen Tsong; Tseng, Chuen Den; Chen, Jin Jer; Tseng, Yun Zu; Lien, Wen Pin.

In: Biomedical Engineering - Applications, Basis and Communications, Vol. 6, No. 1, 01.02.1994, p. 47-58.

Research output: Contribution to journalArticle

@article{cf14c8dae0414ec192ce763f1b972848,
title = "Comparison of local electrogram predictors for successful catheter ablation of left-versus right-sided accessory atrioventricular pathways by radiofrequency current",
abstract = "Analysis of local electrogram manifestations is critical to the success of radiofrequency catheter ablation of accessory atrioventricular (AV) pathways. However, despite similar criteria, the ablation of right-sided targets has been less effective than that of left-sided ones. In order to elucidate the possible variations, we systematically analyzed the morphological and timing characteristics of 215 bipolar local electrograms from ablation sites of 65 left-sided accessory AV pathways, and 356 from those of 37 right-sided ones in 92 consecutive patients. By multivariate analysis, we selected the presence of a possible accessory pathway potential, local ventricular activation preceding QRS complex for 20 ms or more (ventricular insertion mapping); and the local retrograde ventriculoatrial continuity, local retrograde ventriculo-atrial interval ≤50 ms (atrial insertion mapping) as the common independent outcome predictors by local electrogram criteria for ablation of left- and right-sided accessory AV pathways. Electrogram stability for left-sided targets and retrograde accessory pathway potential for right-sided ones were additional indicators during atrial insertion ablation. Combination of all local electrogram predictors could have moderate chance of success for ablation of left-sided accessory AV pathways: positive predictive value of 80{\%} and 51{\%} by ventricular and atrial insertion mapping. However, such combination had either low positive predictive value or very low sensitivity in cases of right-sided accessory AV pathways. In conclusion, successful catheter ablation of right-sided accessory AV pathways, as comparing to left-sided ones, necessitated still more breakthrough in addition to local signal analysis.",
author = "Lin, {Jiunn Lee} and Chen, {Wen Jone} and Schie, {Jen Tsong} and Tseng, {Chuen Den} and Chen, {Jin Jer} and Tseng, {Yun Zu} and Lien, {Wen Pin}",
year = "1994",
month = "2",
day = "1",
language = "English",
volume = "6",
pages = "47--58",
journal = "Journal of Chinese Corrosion Engineering",
issn = "1016-2372",
publisher = "World Scientific Publishing Co. Pte Ltd",
number = "1",

}

TY - JOUR

T1 - Comparison of local electrogram predictors for successful catheter ablation of left-versus right-sided accessory atrioventricular pathways by radiofrequency current

AU - Lin, Jiunn Lee

AU - Chen, Wen Jone

AU - Schie, Jen Tsong

AU - Tseng, Chuen Den

AU - Chen, Jin Jer

AU - Tseng, Yun Zu

AU - Lien, Wen Pin

PY - 1994/2/1

Y1 - 1994/2/1

N2 - Analysis of local electrogram manifestations is critical to the success of radiofrequency catheter ablation of accessory atrioventricular (AV) pathways. However, despite similar criteria, the ablation of right-sided targets has been less effective than that of left-sided ones. In order to elucidate the possible variations, we systematically analyzed the morphological and timing characteristics of 215 bipolar local electrograms from ablation sites of 65 left-sided accessory AV pathways, and 356 from those of 37 right-sided ones in 92 consecutive patients. By multivariate analysis, we selected the presence of a possible accessory pathway potential, local ventricular activation preceding QRS complex for 20 ms or more (ventricular insertion mapping); and the local retrograde ventriculoatrial continuity, local retrograde ventriculo-atrial interval ≤50 ms (atrial insertion mapping) as the common independent outcome predictors by local electrogram criteria for ablation of left- and right-sided accessory AV pathways. Electrogram stability for left-sided targets and retrograde accessory pathway potential for right-sided ones were additional indicators during atrial insertion ablation. Combination of all local electrogram predictors could have moderate chance of success for ablation of left-sided accessory AV pathways: positive predictive value of 80% and 51% by ventricular and atrial insertion mapping. However, such combination had either low positive predictive value or very low sensitivity in cases of right-sided accessory AV pathways. In conclusion, successful catheter ablation of right-sided accessory AV pathways, as comparing to left-sided ones, necessitated still more breakthrough in addition to local signal analysis.

AB - Analysis of local electrogram manifestations is critical to the success of radiofrequency catheter ablation of accessory atrioventricular (AV) pathways. However, despite similar criteria, the ablation of right-sided targets has been less effective than that of left-sided ones. In order to elucidate the possible variations, we systematically analyzed the morphological and timing characteristics of 215 bipolar local electrograms from ablation sites of 65 left-sided accessory AV pathways, and 356 from those of 37 right-sided ones in 92 consecutive patients. By multivariate analysis, we selected the presence of a possible accessory pathway potential, local ventricular activation preceding QRS complex for 20 ms or more (ventricular insertion mapping); and the local retrograde ventriculoatrial continuity, local retrograde ventriculo-atrial interval ≤50 ms (atrial insertion mapping) as the common independent outcome predictors by local electrogram criteria for ablation of left- and right-sided accessory AV pathways. Electrogram stability for left-sided targets and retrograde accessory pathway potential for right-sided ones were additional indicators during atrial insertion ablation. Combination of all local electrogram predictors could have moderate chance of success for ablation of left-sided accessory AV pathways: positive predictive value of 80% and 51% by ventricular and atrial insertion mapping. However, such combination had either low positive predictive value or very low sensitivity in cases of right-sided accessory AV pathways. In conclusion, successful catheter ablation of right-sided accessory AV pathways, as comparing to left-sided ones, necessitated still more breakthrough in addition to local signal analysis.

UR - http://www.scopus.com/inward/record.url?scp=0028374462&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028374462&partnerID=8YFLogxK

M3 - Article

AN - SCOPUS:0028374462

VL - 6

SP - 47

EP - 58

JO - Journal of Chinese Corrosion Engineering

JF - Journal of Chinese Corrosion Engineering

SN - 1016-2372

IS - 1

ER -