Value of local electrogram characteristics predicting successful catheter ablation of left- versus right-sided accessory atrioventricular pathways by radiofrequency current

Jiunn Lee Lin, Jen Tsong Schie, Chuen Den Tseng, Wen Jone Chen, Tin Fu Cheng, Shi Sheng Tsou, Jin Jer Chen, Yung Zu Tseng, Wen Pin Lien

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4 Citations (Scopus)


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 clectrosignal crite-ria. 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.

Original languageEnglish
Pages (from-to)135-142
Number of pages8
JournalCardiology (Switzerland)
Issue number2
Publication statusPublished - Jan 1 1995
Externally publishedYes



  • Accessory atrioventricular pathways
  • Catheter ablation
  • Local electrogram predictors
  • Reentrant tachycardia
  • Wolff-parkinson-white syndrome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

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