Electrocardiographic and electrophysiologic characteristics of midseptal accessory pathways

Shih Ling Chang, Shih Huang Lee, Ching Tai Tai, Chern En Chiang, Jun Jack Cheng, Yenn Jiang Lin, Ming Hsiung Hsieh, Kung Tai Lee, Hsuan Ming Tsao, Jen Yuan Kuo, Yi Jen Chen, Shih Ann Chen

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Characteristics of Midseptal Accessory Pathways. Background: The purpose of the present study was to investigate the electrocardiographic and electrophysiologic characteristics of right midseptal (RMS) and left midseptal (LMS) accessory pathways (APs), and to develop a stepwise algorithm to differentiate RMS from LMS APs. Methods and Results: From May 1989 to February 2004, 1591 patients with AP-mediated tachyarrhythmia underwent RF catheter ablation in this institution, and 38 (2.4%) patients had MS APs. The delta wave and precordial QRS transition during sinus rhythm, retrograde P wave during orthodromic tachycardia, and electrophysiologic characteristic and catheter ablation in 30 patients with RMS APs and 8 patients with LMS APs were analyzed. There was no significant difference in electrophysiologic characteristics and catheter ablation between RMS and LMS APs. The polarity of retrograde P wave during orthodromic tachycardia also showed no statistical difference between patients with RMS and LMS APs. The delta wave polarity was positive in leads I, aVL, and V3 to V6 in patients with RMS and LMS APs. Patients with LMS APs had a higher incidence of biphasic delta wave in lead V1 than patients with RMS APs (80% vs. 15%, P = 0.012). The distributions of precordial QRS transition were different between RMS APs (leads V2; n = 10, V3; n = 7 and V4; n = 3) and LMS APs (leads V1; n = 1 and V2; n = 4) (P = 0.03). The combination of a delta negative wave in lead V1 or precordial QRS transition in lead V3 or V4 had a sensitivity of 90%, specificity of 80%, positive predictive value of 95%, and negative predictive value of 66% in predicting an RMS AP. Conclusions: Delta wave polarity in lead V1 and precordial QRS transition may differentiate RMS and LMS APs.

Original languageEnglish
Pages (from-to)237-243
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Volume16
Issue number3
DOIs
Publication statusPublished - Mar 2005
Externally publishedYes

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Patient Rights
Catheter Ablation
Tachycardia
Sensitivity and Specificity
Lead
Incidence

Keywords

  • Ablation
  • Accessory pathway
  • Electrocardiography
  • Electrophysiology
  • Midseptum

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

Chang, S. L., Lee, S. H., Tai, C. T., Chiang, C. E., Cheng, J. J., Lin, Y. J., ... Chen, S. A. (2005). Electrocardiographic and electrophysiologic characteristics of midseptal accessory pathways. Journal of Cardiovascular Electrophysiology, 16(3), 237-243. https://doi.org/10.1046/j.1540-8167.2005.40485.x

Electrocardiographic and electrophysiologic characteristics of midseptal accessory pathways. / Chang, Shih Ling; Lee, Shih Huang; Tai, Ching Tai; Chiang, Chern En; Cheng, Jun Jack; Lin, Yenn Jiang; Hsieh, Ming Hsiung; Lee, Kung Tai; Tsao, Hsuan Ming; Kuo, Jen Yuan; Chen, Yi Jen; Chen, Shih Ann.

In: Journal of Cardiovascular Electrophysiology, Vol. 16, No. 3, 03.2005, p. 237-243.

Research output: Contribution to journalArticle

Chang, SL, Lee, SH, Tai, CT, Chiang, CE, Cheng, JJ, Lin, YJ, Hsieh, MH, Lee, KT, Tsao, HM, Kuo, JY, Chen, YJ & Chen, SA 2005, 'Electrocardiographic and electrophysiologic characteristics of midseptal accessory pathways', Journal of Cardiovascular Electrophysiology, vol. 16, no. 3, pp. 237-243. https://doi.org/10.1046/j.1540-8167.2005.40485.x
Chang, Shih Ling ; Lee, Shih Huang ; Tai, Ching Tai ; Chiang, Chern En ; Cheng, Jun Jack ; Lin, Yenn Jiang ; Hsieh, Ming Hsiung ; Lee, Kung Tai ; Tsao, Hsuan Ming ; Kuo, Jen Yuan ; Chen, Yi Jen ; Chen, Shih Ann. / Electrocardiographic and electrophysiologic characteristics of midseptal accessory pathways. In: Journal of Cardiovascular Electrophysiology. 2005 ; Vol. 16, No. 3. pp. 237-243.
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abstract = "Characteristics of Midseptal Accessory Pathways. Background: The purpose of the present study was to investigate the electrocardiographic and electrophysiologic characteristics of right midseptal (RMS) and left midseptal (LMS) accessory pathways (APs), and to develop a stepwise algorithm to differentiate RMS from LMS APs. Methods and Results: From May 1989 to February 2004, 1591 patients with AP-mediated tachyarrhythmia underwent RF catheter ablation in this institution, and 38 (2.4{\%}) patients had MS APs. The delta wave and precordial QRS transition during sinus rhythm, retrograde P wave during orthodromic tachycardia, and electrophysiologic characteristic and catheter ablation in 30 patients with RMS APs and 8 patients with LMS APs were analyzed. There was no significant difference in electrophysiologic characteristics and catheter ablation between RMS and LMS APs. The polarity of retrograde P wave during orthodromic tachycardia also showed no statistical difference between patients with RMS and LMS APs. The delta wave polarity was positive in leads I, aVL, and V3 to V6 in patients with RMS and LMS APs. Patients with LMS APs had a higher incidence of biphasic delta wave in lead V1 than patients with RMS APs (80{\%} vs. 15{\%}, P = 0.012). The distributions of precordial QRS transition were different between RMS APs (leads V2; n = 10, V3; n = 7 and V4; n = 3) and LMS APs (leads V1; n = 1 and V2; n = 4) (P = 0.03). The combination of a delta negative wave in lead V1 or precordial QRS transition in lead V3 or V4 had a sensitivity of 90{\%}, specificity of 80{\%}, positive predictive value of 95{\%}, and negative predictive value of 66{\%} in predicting an RMS AP. Conclusions: Delta wave polarity in lead V1 and precordial QRS transition may differentiate RMS and LMS APs.",
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AU - Lin, Yenn Jiang

AU - Hsieh, Ming Hsiung

AU - Lee, Kung Tai

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