Effect of electrophysiologic properties and location of manifest accessory pathways on local electrogram intervals at effective radiofrequency ablation sites

Abstract

The purpose of this study was to determine if the electrophysiologic properties and the anatomic location of manifest accessory pathways affect the local electrogram intervals recorded at sites of successful radiofrequency ablation. Accessory pathways in 149 consecutive patients were categorized according to their anatomic location on the basis of the site of successful ablation. Three anatomic groups comprised 90 left free wall, 28 right free wall, and 31 posteroseptal pathways. The accessory pathways were also categorized according to their electrophysiologic properties on the basis of a hierarchical classification of the accessory pathway block cycle length. Four electrophysiologic groups (A, B, C, and D) comprised 54, 51, 28, and 16 accessory pathways, with mean accessory pathway block cycle lengths of 254 ± 9, 288 ± 10, 347 ± 19, and 458 ± 56 msec, respectively. The local atrial to ventricular (A-V) and atrial to accessory (A-K) pathway electrogram intervals recorded in sinus rhythm at the successful ablation site were significantly affected by the electrophysiologic group and were longest in group D compared with groups A, B, and C (A-V interval F (3,145) = 13.6, p < 0.001; A-K interval F (3,88) = 12.6, p < 0.001). The local A-V interval was also affected by the anatomic group and was longer in posteroseptal compared with free wall accessory pathways (F (2,146) = 15.0, p < 0.001). In contrast, the timing of the local ventricular activation to the delta wave onset (δ-V) was not significantly affected by the electrophysiologic group or the anatomic location of the accessory pathway. Thus the local A-V interval at the successful ablation site may vary because it is affected by the electrophysiologic properties and location of the accessory pathway, whereas the δ-V interval remains unaffected. These effects should be taken into account when selecting ablation sites in patients with manifest accessory pathways.