PMID- 12212691
OWN - NLM
STAT- MEDLINE
DCOM- 20030128
LR  - 20191210
IS  - 1045-3873 (Print)
IS  - 1045-3873 (Linking)
VI  - 13
IP  - 8
DP  - 2002 Aug
TI  - Usefulness of paced activation sequence mapping in catheter ablation of accessory 
      pathways.
PG  - 750-6
AB  - INTRODUCTION: Radiofrequency (RF) ablation of accessory pathways (APs) is often a 
      time-consuming procedure, mainly because conventional criteria have modest 
      accuracy. Thus, additional mapping criteria are desirable. Our hypothesis was 
      that comparison of paced atrial activation sequences with that obtained during 
      orthodromic AV reentrant tachycardia might be useful for locating the atrial 
      insertion of single APs. METHODS AND RESULTS: The study included 15 patients with 
      a single AP referred for ablation. Analysis of the atrial activation sequence was 
      simplified by measuring the activation time (AT) that elapsed between two atrial 
      reference points placed next to the AV annulus on either side of the area 
      containing the AP. Ablation was guided by conventional criteria. Before each RF 
      delivery, a short pacing train was delivered from the ablation catheter and, 
      after verification of atrial capture, the AT was compared with the AT obtained 
      during orthodromic tachycardia. Fifty sites of RF delivery were appropriate for 
      analysis. The multivariate model with the highest predictive power included a 
      deviation of AT between pacing and tachycardia < or = 5 msec (P < 0.001), a local 
      AV ratio > or = 1 (P = 0.04), and stability of the local electrogram (P = 0.05). 
      The combination of all these criteria predicted a successful application with 
      high sensitivity, specificity, and positive predictive value (92%, 86%, and 71% 
      respectively). To validate the method prospectively, 10 additional consecutive 
      patients underwent an AP ablation procedure guided by these criteria. CONCLUSION: 
      This technique seems to be highly accurate in selecting the atrial site for RF 
      ablation of single APs.
FAU - Perez-Castellano, Nicasio
AU  - Perez-Castellano N
AD  - Division of Cardiology, Gregorio Marafnon General Hospital, Madrid, Spain. 
      npc@jet.es
FAU - Almendral, Jesus
AU  - Almendral J
FAU - Villacastin, Julian
AU  - Villacastin J
FAU - Arenal, Angel
AU  - Arenal A
FAU - Gonzalez, Sergio
AU  - Gonzalez S
FAU - Moreno, Javier
AU  - Moreno J
FAU - Ortiz, Mercedes
AU  - Ortiz M
FAU - Torrecilla, Esteban
AU  - Torrecilla E
FAU - Macaya, Carlos
AU  - Macaya C
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Validation Study
PL  - United States
TA  - J Cardiovasc Electrophysiol
JT  - Journal of cardiovascular electrophysiology
JID - 9010756
SB  - IM
MH  - Accessory Nerve/*pathology/*surgery
MH  - *Body Surface Potential Mapping
MH  - *Cardiac Pacing, Artificial
MH  - *Catheter Ablation
MH  - Electrophysiologic Techniques, Cardiac
MH  - Heart Atria/pathology/surgery
MH  - Heart Conduction System/pathology/surgery
MH  - Humans
MH  - Logistic Models
MH  - Observer Variation
MH  - Predictive Value of Tests
MH  - Reproducibility of Results
MH  - Sensitivity and Specificity
MH  - Tachycardia, Atrioventricular Nodal Reentry/*diagnosis/epidemiology/*therapy
MH  - Treatment Outcome
EDAT- 2002/09/06 10:00
MHDA- 2003/01/29 04:00
CRDT- 2002/09/06 10:00
PHST- 2002/09/06 10:00 [pubmed]
PHST- 2003/01/29 04:00 [medline]
PHST- 2002/09/06 10:00 [entrez]
AID - 10.1046/j.1540-8167.2002.00750.x [doi]
PST - ppublish
SO  - J Cardiovasc Electrophysiol. 2002 Aug;13(8):750-6. doi: 
      10.1046/j.1540-8167.2002.00750.x.