Intermediate septal accessory pathways: electrocardiographic characteristics, electrophysiologic observations and their surgical implications
AE Epstein,
JK Kirklin,
WL Holman,
VJ Plumb,
and
GN Kay
Department of Medicine, University of Alabama, Birmingham 35294.
Intermediate septal accessory pathways are located in close proximity to the atrioventricular (AV) node and His bundle, have unique features that distinguish them from typical anterior and posterior accessory pathways and have been associated with a high risk for unsuccessful pathway division and the production of complete AV block after surgery. Between July 1986 and May 1990, 4 of 70 patients (3 men and 1 woman; mean age 33 +/- 13 years) undergoing surgery for accessory pathway division were found to have an intermediate septal accessory pathway. The presenting arrhythmia was atrial fibrillation with rapid anterograde conduction over the accessory pathway in two patients and recurrent orthodromic reciprocating tachycardia in two patients. In all patients, the delta wave on the electrocardiogram (ECG) was inverted in lead V1, but two patterns of delta wave configuration were observed. In three patients (type 1 intermediate septal accessory pathway), the delta wave was upright in lead II, inverted in lead III and isoelectric in lead a VF; the transition from a negative to an upright delta wave occurred in lead V2. The fourth patient exhibited a different delta wave pattern (type 2 intermediate septal accessory pathway). The delta wave was upright in each of leads II, III and aVF; the transition from a negative to an upright delta wave occurred at lead V3. Intraoperative electrophysiologic study localized the atrial insertion of type 1 pathways to the midpoint of Koch's triangle close to the AV node.(ABSTRACT TRUNCATED AT 250 WORDS)
This article has been cited by other articles:
|
|
|
|
 
H. Bastani, P. Insulander, J. Schwieler, F. Tabrizi, F. Braunschweig, G. Kenneback, N. Drca, and M. Jensen-Urstad
Cryoablation of superoparaseptal and septal accessory pathways: a single centre experience
Europace,
July 1, 2010;
12(7):
972 - 977.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Gatzoulis, T. Apostolopoulos, X. Costeas, H. Sotiropoulos, F. Papafanis, C. Stefanadis, and P. Toutouzas
Paraseptal accessory connections in the proximity of the atrioventricular node and the His bundle. Additional observations in relation to the ablation technique in a high risk area
Europace,
January 1, 2004;
6(1):
1 - 9.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. S. Schaffer, M. J. Silka, B. A. Ross, and J. D. Kugler
Inadvertent Atrioventricular Block During Radiofrequency Catheter Ablation: Results of the Pediatric Radiofrequency Ablation Registry
Circulation,
December 15, 1996;
94(12):
3214 - 3220.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
G. M. Guiraudon
Surgical treatment of Wolff-Parkinson-White syndrome: A "retrospectroscopic" view
Ann. Thorac. Surg.,
October 1, 1994;
58(4):
1254 - 1261.
[Abstract]
[PDF]
|
|
|
|
