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 journalArticlepeer-review

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

ASJC Scopus subject areas

  • Biophysics
  • Bioengineering
  • Biomedical Engineering

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