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12. AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram: Part VI: Acute Ischemia/Infarction A Scientific Statement From the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society Endorsed by the International Society for Computerized Electrocardiology

Author

Wagner, Galen S., Macfarlane, Peter, Wellens, Hein, Josephson, Mark, Gorgels, Anton, Mirvis, David M., Pahlm, Olle, Surawicz, Borys, Kligfield, Paul, Childers, Rory, and Gettes, Leonard S.

Published
2009
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26. Miniseries 2-Septal and paraseptal accessory pathways-Part II: Para-Hisian accessory pathways-so-called anteroseptal pathways revisited.

Author

Farré, Jerónimo, Anderson, Robert H, Sánchez-Quintana, Damián, Mori, Shumpei, Rubio, José-Manuel, García-Talavera, Camila, Bansal, Raghav, Lokhandwala, Yash, Cabrera, José-Angel, Wellens, Hein J J, and Sternick, Eduardo Back

Abstract

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. [ABSTRACT FROM AUTHOR]

Published
2022
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27. Miniseries 2-Septal and paraseptal accessory pathways-Part I: The anatomic basis for the understanding of para-Hisian accessory atrioventricular pathways.

Author

Anderson, Robert H, Sanchez-Quintana, Damian, Mori, Shumpei, Spicer, Diane E, Wellens, Hein J J, Lokhwandala, Yash, Cabrera, Jose-Angel, Farre, Jeronimo, and Sternick, Eduardo Back

Abstract

Aims: Although the anatomy of the atrioventricular conduction axis was well described over a century ago, the precise arrangement in the regions surrounding its transition from the atrioventricular node to the so-called bundle of His remain uncertain. We aimed to clarify these relationships.Methods and Results: We have used our various datasets to examine the development and anatomical arrangement of the atrioventricular conduction axis, paying particular attention to the regions surrounding the point of penetration of the bundle of His. It is the areas directly adjacent to the transition of the atrioventricular conduction axis from the atrioventricular node to the non-branching atrioventricular bundle that constitute the para-Hisian areas. The atrioventricular conduction axis itself traverses the membranous part of the ventricular septum as it extends from the node to become the bundle, but the para-Hisian areas themselves are paraseptal. This is because they incorporate the fibrofatty tissues of the inferior pyramidal space and the superior atrioventricular groove. In this initial overarching review, we summarize the developmental and anatomical features of these areas along with the location and landmarks of the atrioventricular conduction axis. We emphasize the relationships between the inferior pyramidal space and the infero-septal recess of the subaortic outflow tract. The details are then explored in greater detail in the additional reviews provided within our miniseries.Conclusion: Our anatomical findings, described here, provide the basis for our concomitant clinical review of the so-called para-Hisian arrhythmias. The findings also provide the basis for understanding the other variants of ventricular pre-excitation. [ABSTRACT FROM AUTHOR]

Published
2022
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28. Miniseries 2-Septal and paraseptal accessory pathways-Part IV: Inferior paraseptal accessory pathways-lessons from surgical and catheter ablation.

Author

Farré, Jerónimo, Anderson, Robert H, Rubio, José-Manuel, Tretter, Justin T, Sánchez-Quintana, Damián, García-Talavera, Camila, Bansal, Raghav, Lokhandwala, Yash Yahya, Cabrera, José-Angel, Wellens, Hein J J, Sternick, Eduardo Back, and Back Sternick, Eduardo

Abstract

Surgeons and electrophysiologists performing accessory pathway ablation procedures have used the term 'posteroseptal' region. This area, however, is neither septal nor posterior, but paraseptal and inferior; paraseptal because it includes the fibro-adipose tissues filling the pyramidal space and not the muscular septum itself and inferior because it is part of the heart adjacent to the diaphragm. It should properly be described, therefore, as being inferior and paraseptal. Pathways in this region can be ablated at three areas, which we term right inferior, mid-inferior, and left inferior paraseptal. The right- and left inferior paraseptal pathways connect the right and left atrial vestibules with the right and left paraseptal segments of the parietal ventricular walls. The mid-inferior paraseptal pathways take a subepicardial course from the myocardial sleeves surrounding the coronary sinus and its tributaries. Our review addresses the evolution of the anatomical concept of the inferior paraseptal region derived from surgical and catheter ablation procedures. We also highlight the limitations of the 12-lead electrocardiogram in identifying, without catheter electrode mapping, which are the pathways that can be ablated without a coronary sinus, or left heart approach. [ABSTRACT FROM AUTHOR]

Published
2022
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29. Implantable defibrillator early after primary percutaneous intervention for ST-elevation myocardial infarction: Rationale and design of the Defibrillator After Primary Angioplasty (DAPA) Trial

Author

Ottervanger, Jan Paul, Ramdat Misier, Anand R., Zijlstra, Felix, Schalij, Martin J., Wever, Eric, Jordaens, Luc J.L.M., Henriques, Jose P.S., de Boer, Menko-Jan, Robbe, Hindrik W.J., and Wellens, Hein J.J.

Subjects
Implantable cardioverter-defibrillators -- Usage, Implantable cardioverter-defibrillators -- Research, Heart attack -- Care and treatment, Cardiac patients -- Care and treatment, Cardiac patients -- Physiological aspects, Cardiac patients -- Research, Health
Published
2006

49. Early referral for intentional rescue PTCA after initiation of thrombolytic therapy in patients admitted to a community hospital because of a large acute myocardial infarction

Author

Ophuis, Ton J.M. Oude, Bar, Frits W., Vermeer, Frank, Krijne, Ruud, Jansen, Ward, Swart, Hans de, Ommen, Vincent van, Zwaan, Chris de, Engelen, Domien, Dassen, Willem R., and Wellens, Hein J.J.

Subjects
Medical referral -- Evaluation, Transluminal angioplasty -- Health aspects, Heart attack -- Care and treatment, Thrombolytic therapy -- Usage, Health
Published
1999

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