Abstract
Aims: In 1999 the consensus statement “living anatomy of the atrioventricular junctions” was published. With that new nomenclature the former posteroseptal accessory pathway (APs) are termed paraseptal APs. The aim of this study was to identify ECG features of manifest APs located in this complex paraseptal space.
Methods and Results: ECG characteristics of all patients who underwent radiofrequency ablation of an AP during a 3 year period were analyzed. Of the 239 patients with one or more APs, 30 patients had a paraseptal AP with preexcitation. Compared to APs within the coronary sinus (CS) or the middle cardiac vein (MCV) the right sided paraseptal APs significantly more often showed an isoelectric delta wave in lead II and/or a negative delta wave in aVR. The left sided paraseptal APs presented a negative delta wave in II significantly more often compared to the right sided APs.
Conclusions: According to the site of radiofrequency ablation, paraseptal APs are classified into 4 subgroups: paraseptal right, paraseptal left, inside the CS or inside the MCV. Subtle differences in preexcitation patterns of the delta wave as well as of the QRS complex exist. However, the definitive localization of APs remains reserved to the periinterventional intracardiac electrogram analysis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Morady F. Radio-frequency ablation as treatment for cardiac arrhythmias. N Engl J Med 1999;340:534–544.
Calkins H, Sousa J, el-Atassi R, Rosenheck S, de Buitleir M, Kou WH, Kadish AH, Langberg JJ, Morady F. Diagnosis and cure of the Wolff-Parkinson-White syndrome or paroxysmal supraventricular tachycardias during a single electrophysiologic test. N Engl J Med 1991;324:1612-1618.
Cosio FG, Anderson RH, Becker A, Borggrefe M, Campbell RW, Gaita F, Guiraudon GM, Haissaguerre M, Kuck KJ, Rufilanchas JJ, Thiene G, Wellens HJ, Langberg J, Benditt DG, Bharati S, Klein G, Marchlinski F, Saksena S. Living anatomy of the atrioventricular junctions. A guide to electrophysiological mapping. A consensus statement from the cardiac nomenclature study group, working group of arrythmias, european society of cardiology, and the task force on cardiac nomenclature from NASPE. North American Society of Pacing and Electrophysiology. Eur Heart J 1999;20:1068–1075.
Sanchez-Quintana D, Ho SY, Cabrera JA, Farre J, Anderson RH J. Topographic anatomy of the inferior pyramidal space: Relevance to radiofrequency catheter ablation. Cardiovasc Electrophysiol 2001;12:210–217.
Dean JW, Ho SY, Rowland E, Mann J, Anderson RH. Clinical anatomy of the atrioventricular junctions. J Am Coll Cardiol 1994;24:1725–1731.
Anderson RH, Ho SY, Becker AE. Anatomy of the human atrioventricular junctions revisited. Anat Rec 2000;260:81–91.
Chauvin M, Shah DC, Haissaguerre M, Marcellin L, Brechenmacher C. The anatomic basis of connections between the coronary sinus musculature and the left atrium in humans. Circulation 2000;101:647–652.
Ludinghausen M, Ohmachi N, Boot C. Myocardial coverage of the coronary sinus and related veins. Clin Anat 1992;5:1–15.
Sun Y, Arruda M, Otomo K, Beckman K, Nakagawa H, Calame J, Po S, Spector P, Lustgarten D, Herring L, Lazzara R, Jackman W. Coronary sinus-ventricular accessory connections producing posteroseptal and left posterior accessory pathways: Incidence and electrophysiological identification. Circulation 2002;106:1362–1367.
Fitzpatrick AP, Gonzales RP, Lesh MD, Modin GW, Lee RJ, Scheinman MM. New algorithm for the localization of accessory atrioventricular connections using a baseline electrocardiogram. J Am Coll Cardiol 1994;23:107–116.
Arruda MS, McClelland JH, Wang X, Beckman KJ, Widman LE, Gonzalez MD, Nakagawa H, Lazzara R, Jackman WM. Development and validation of an ECG algorithm for identifying accessory pathway ablation site in Wolff-Parkinson-White syndrome. J Cardiovasc Electrophysiol 1998;9:2–12.
Boersma L, Garcia-Moran E, Mont L, Brugada J. Accessory pathway localization by QRS polarity in children with Wolff- Parkinson-White syndrome. J Cardiovasc Electrophysiol 2002;13:1222–1226.
Takahashi A, Shah DC, Jais P, Hocini M, Clementy J, Haissaguerre M. Specific electrocardiographic features of manifest coronary vein posteroseptal accessory pathways. J Cardiovasc Electrophysiol 1998;9:1015–1025.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kobza, R., Hindricks, G., Tanner, H. et al. Paraseptal Accessory Pathway in Wolff-Parkinson- White-Syndrom: Ablation from the Right, from the Left or within the Coronary Sinus/Middle Cardiac Vein?. J Interv Card Electrophysiol 12, 55–60 (2005). https://doi.org/10.1007/s10840-005-5841-2
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s10840-005-5841-2