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.
|頁（從 - 到）||47-58|
|期刊||Biomedical Engineering - Applications, Basis and Communications|
|出版狀態||已發佈 - 2月 1 1994|
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