Key result
Pacing maneuvers predict the right septal approach for accessory pathway ablation with 100% sensitivity.
Why the study?
Accurate localization of manifest posteroseptal accessory pathways during electrophysiological study is challenging due to complex inferior paraseptal anatomy.
Do simple pacing maneuvers during electrophysiological study predict the optimal ablation approach in patients with manifest posteroseptal accessory pathways?
Observational (n=65)
Do simple pacing maneuvers during electrophysiological study predict the optimal ablation approach in patients with manifest posteroseptal accessory pathways?
p-value: p=<0.001
Simple pacing maneuvers during electrophysiological study, such as the number of QRS complexes with fixed SA in the transition zone, can accurately predict the optimal ablation approach for manifest posteroseptal accessory pathways.
May assist right- versus left-sided approach selection during ablation; leaves open prospective validation before routine use.
Background Accurate localization of posteroseptal (inferior paraseptal) APs during electrophysiological study (EPS) often pose diagnostic challenges due to the complex anatomy of the inferior paraseptal region. Aim We aimed to study simple pacing maneuvers for differentiating manifest posteroseptal APs, which can be ablated from a right- or left-sided approach. Patients and methods 65 patients with possible manifest posteroseptal AP were included in a prospective observational study. EPS and ablation were done for all patients. During EPS, we measured the stimulus to atrial (SA) interval during right ventricular (RV) posterobasal septal and apical pacing (basal & apical SA) in sinus rhythm, SA index (basal SA-apical SA interval) and, the number of QRS complexes showing fixed SA interval in the transition zone during RV entrainment of orthodromic atrioventricular tachycardia. Results 65 patients (48% male) were included with a mean age of 32.8 ± 10 years. SA interval during posterobasal RV pacing can significantly predict the right septal approach at a cut-off ≤113 with 73.1 % sensitivity, 77.3 % specificity (P < 0.001 and AUC = 0.836). SA index <0 can also predict right septal approach with 87.5% sensitivity and 100% specificity (P <0.001). Also, the number of QRS with fixed SA in the transition zone predict the right septal approach group, with a cut-off of >2, yielding 100.0% sensitivity and 93.3% specificity (P < 0.001, AUC = 0.990). Conclusion Our study demonstrated that simple and practical pacing maneuvers can effectively predict the optimal ablation approach for manifest posteroseptal accessory pathways with near-perfect diagnostic accuracy. Trial registration number (IRB) 04-2023-200550
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Mahmoud et al. (2026) conducted an observational in Manifest posteroseptal accessory pathway (n=65). Pacing maneuvers during electrophysiological study was evaluated on Prediction of the right septal approach for ablation (p=<0.001). Pacing maneuvers, such as the number of QRS complexes with fixed SA interval >2, predicted the right septal approach for accessory pathway ablation with 100% sensitivity and 93.3% specificity.
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