BACKGROUND: Radiofrequency ablation of atrioventricular accessory pathway is widely used to cure patients with the Wolff-Parkinson-White syndrome. The site of successful ablation is determined using electrophysiological parameters, endocavitary bipolar electrogram measurements being the most commonly used. Interobserver reproducibility of these measurements may limit the reliability of ablation criteria based upon bipolar measurements only but, to our knowledge, this reproducibility has not been evaluated so far. Such was the aim of this study. METHODS: Three independent observers reviewed the bipolar electrograms recorded at sites were radiofrequency energy was delivered (successfully or not) in 28 consecutive patients with the Wolff-Parkinson-White syndrome. In each tracing, 4 intervals were measured: (1) A0V0 (onset of the atrial electrogram to onset of the ventricular electrogram), (2) AaVa (activation time of the atrial electrogram to activation time of the ventricular electrogram), (3) V0-QRS (onset of the ventricular electrogram to onset of delta wave on the surface ECG) and (4) Va-QRS (activation time of the ventricular electrogram to onset of delta wave on the surface ECG). RESULTS: The interobserver reproducibility was low since only 50% of A0V0 intervals were measured with an interobserver difference lower than 10 ms and up to 43% of Va-QRS intervals were measured with an interobserver difference greater than 30 ms. The reproducibility of interval measurement was graded from the highest to the lowest as follows: A0V0, AaVa, V0-QRS and Va-QRS (Chi-square statistic, chi 2 = 71.72, p < 0.0001). Kappa values were lower than 0.40, indicating a poor interobserver reproducibility. CONCLUSIONS: Our study suggests that interobserver reproducibility of only bipolar electrograms interval measurements at sites of radiofrequency ablation of atrioventricular accessory pathway is poor, which limits the reliability of bipolar criteria to predict a successful ablation site.
BACKGROUND: Radiofrequency ablation of atrioventricular accessory pathway is widely used to cure patients with the Wolff-Parkinson-White syndrome. The site of successful ablation is determined using electrophysiological parameters, endocavitary bipolar electrogram measurements being the most commonly used. Interobserver reproducibility of these measurements may limit the reliability of ablation criteria based upon bipolar measurements only but, to our knowledge, this reproducibility has not been evaluated so far. Such was the aim of this study. METHODS: Three independent observers reviewed the bipolar electrograms recorded at sites were radiofrequency energy was delivered (successfully or not) in 28 consecutive patients with the Wolff-Parkinson-White syndrome. In each tracing, 4 intervals were measured: (1) A0V0 (onset of the atrial electrogram to onset of the ventricular electrogram), (2) AaVa (activation time of the atrial electrogram to activation time of the ventricular electrogram), (3) V0-QRS (onset of the ventricular electrogram to onset of delta wave on the surface ECG) and (4) Va-QRS (activation time of the ventricular electrogram to onset of delta wave on the surface ECG). RESULTS: The interobserver reproducibility was low since only 50% of A0V0 intervals were measured with an interobserver difference lower than 10 ms and up to 43% of Va-QRS intervals were measured with an interobserver difference greater than 30 ms. The reproducibility of interval measurement was graded from the highest to the lowest as follows: A0V0, AaVa, V0-QRS and Va-QRS (Chi-square statistic, chi 2 = 71.72, p < 0.0001). Kappa values were lower than 0.40, indicating a poor interobserver reproducibility. CONCLUSIONS: Our study suggests that interobserver reproducibility of only bipolar electrograms interval measurements at sites of radiofrequency ablation of atrioventricular accessory pathway is poor, which limits the reliability of bipolar criteria to predict a successful ablation site.
Authors: M J Silka; J Kron; B D Halperin; K Griffith; B Crandall; R P Oliver; C G Walance; J H McAnulty Journal: Pacing Clin Electrophysiol Date: 1992-07 Impact factor: 1.976
Authors: H Calkins; Y N Kim; S Schmaltz; J Sousa; R el-Atassi; A Leon; A Kadish; J J Langberg; F Morady Journal: Circulation Date: 1992-02 Impact factor: 29.690
Authors: M Haissaguerre; B Fischer; J F Warin; J F Dartigues; P Lemétayer; P Egloff Journal: Pacing Clin Electrophysiol Date: 1992-11 Impact factor: 1.976