Delta Wave In V1 Research Articles

Miniseries 2-Septal and paraseptal accessory pathways-Part II: Para-Hisian accessory pathways-so-called anteroseptal pathways revisited.

Surgeons, when dividing bypass tracts adjacent to the His bundle, considered them to be 'anteroseptal'. The area was subsequently recognized to be superior and paraseptal, although this description is not entirely accurate anatomically, and conveys little about the potential risk during catheter interventions. We now describe the area as being para-Hisian, and it harbours two types of accessory pathways. The first variant crosses the membranous septum to insert into the muscular ventricular septum without exiting the heart, and hence being truly septal. The second variant inserts distally in the paraseptal components of the supraventricular crest, and consequently is crestal. The site of ventricular insertion determines the electrocardiographic expression of pre-excitation during sinus rhythm, with the two types producing distinct patterns. In both instances, the QRS and the delta wave are positive in leads I, II, and aVF. In crestal pathways, however, the QRS is ≥ 140 ms, and exhibits an rS configuration in V1-2. The delta wave in V1-2 precedes by 20-50 ms the apparent onset of the QRS in I, II, III, and aVF. In the true septal pathways, the QRS complex occupies ∼120 ms, presenting a QS, W-shaped, morphology in V1-2. The delta wave has a simultaneous onset in all leads. Our proposed terminology facilitates the understanding of the electrocardiographic manifestations of both types of para-Hisian pathways during pre-excitation and orthodromic tachycardia, and informs on the level of risk during catheter ablation.

12 Lead electrocardiogram algorithm for the localization of accessory pathways using simple parameters in patients with typical Wolff-Parkinson-White syndrome

Objective: This study was designed to characteristics of 12-lead electrocardiogram (ECG) to compare the position of accessory pathway (APs) in the typical Wolff-Parkinson-White (WPW) syndrome, can be build a new ECG algorithm for the localization of AP. Subjects and method: In 189 patients with typical WPW syndrome have a single anterogradely conducting APs on 12-lead ECG parameters were compared with the localization of APs identified by successful radiofrequency catheter ablation (RCFA). Results: We have developed a new ECG algorithm in localizing APs by the 12-lead ECG with simple parameters such as difference between the left or right side by positive/negative delta wave in V1, the anterior or posterior sites by positive/negative delta wave in at least 2/3 inferior lead, the septal or free wall sites by QRS complex transition in V1V2 lead or after V1V2/before V1; Different in LAL or LL region by R/S>1 or R/S<1, R in V1, the RL or RPL region by positive/negative QRS complex in at least 2/3 inferior lead, midseptal had QRS complex morphology’s specify (Qrs, qRs, qrS) in at least 1/3 inferior lead. The new ECG algorithm had high predictive value from 74.5% to 100%; The ECG parameters in algorithm were closely related to AP position. Conclusion: The 12-lead ECG parameters in typical WPW syndrome closely related to APs localization and can be used to a new ECG algorithm for the localization of AP by simple parameters.

Interesting ECG Pattern in Accessory Pathway of Crux

Using Electrocardiographic criteria is usual for determining the best site for ablating accessory pathways. Many algorithms are present in this regard, but there are still many facts to be found. The present study aimed to reduce fluoroscopic time by using a special electrocardiographic sign. This study was performed on a young lady with palpitation, negative delta wave in V1 and V3, and positive delta wave in V2. Positive delta in V2 intervened with negative delta in V1 and V3 localized in the crux area for accessory pathway. This might help reduce the procedure time and increase the success rate. This exceptional electrocardiography could be used to locate the site of ablation, increase the rate of success, and reduce radiation exposure.

An Asymptomatic Case of Wolff-Parkinson-White Syndrome with Right-sided Free-wall Accessory Pathway and Left Ventricular Dysfunction

A 16-year-old girl with a known history of asymptomatic Wolff-Parkinson-White syndrome exhibited signs of left ventricular (LV) septal akinesia and LV dysfunction during routine follow-up. A 12-lead surface ECG showed pre-excitation, a predominantly negative delta wave in V1 and left axis deviation, which was consistent with the presence of a right free-wall accessory pathway. Radiofrequency ablation of the anterolateral right atrium around the local shortest atrium-to-ventricle interval created the accessory pathway block. An echocardiogram taken one month after the procedure revealed that LV septal wall motion had normalized and that LV ejection fraction had improved from 50% before the ablation to 64% after the ablation. Most previous reports of asymptomatic patients of WPW with LV septal dyskinesia and dysfunction have described right septal or posteroseptal accessory pathways. This patient reported here represents a rare case with right free-wall accessory pathway and LV dysfunction without tachycardia.

Cryoablation of two accessory pathways in a single session: Appraisal of a direct cryoablation approach in right septal locations

MOTS CLES Cryoablation ; Voies accessoires multiples ; Syndrome de WolffA 37-year-old woman with Wolff-Parkinson-White syndrome had experienced atrioventricular re-entrant tachycardias for 3 years. The standard ECG showed a shortened PQ interval, a positive delta wave in leads I, II and aVF and a negative delta wave in V1, suggesting a parahisian AP location (Fig. 1A). A first electrophysiological procedure confirmed this location with the earliest ventricular activation during antegrade conduction recorded in the His-bundle area anteriorly on the His-bundle catheter. The patient was treated with antiarrhythmic drug therapy, but after several months, she remained symptomatic, so a second electrophysiological study was performed, confirming the parahisian location. Cryoablation was applied without a prior transient cryomapping test as is usually recommended in such procedures. One application of cryoenergy at −70 ◦C caused a sudden loss of ventricular pre-excitation (Fig. 1B). The initial pre-excitation completely disappeared but, surprisingly, we observed a persistent short atrioventricular delay. The ECG showed a shortened PQ interval, a positive delta wave in leads I and aVL and a negative delta wave in leads III, aVF and V1, suggesting a dormant posteroseptal AP location (Fig. 2A and B). The earliest site of ventricular activation during antegrade conduction was recorded in the