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The acute anatomic and valvular consequences of radiofrequency catheter ablation of accessory pathways were evaluated in 62 patients by means of serial echocardiographic examinations. Semiquantitative assessment of valvular incompetence and classification into one of four grades according to the width and the extension of the jet from the valvular orifice were carried out. Segmental wall motion abnormalities were evaluated semiquantitatively with four grades of severity (normal, hypokinesia, akinesia, or dyskinesia). New echocardiographic abnormalities were observed in five patients. One thrombus on the ventricular aspect of the mitral valve, three hemodynamically insignificant pericardial effusions, and one increase in severity of tricuspid incompetence were found 1 day after radiofrequency catheter ablation. We conclude that echocardiographic changes after radiofrequency ablation of accessory pathways are rare and of minor significance. These findings confirm the safety of the procedure.

The 12-lead electrocardiograms of 50 patients with 1 anterogradely conducting accessory pathway were analyzed to obtain characteristics of electrocardiographic findings in the midseptal, anteroseptal, true posteroseptal and right free wall accessory pathway locations. Locations were confirmed by surgery (33 patients) or radiofrequency catheter ablation (17 patients). This study analyzed (1) QRS in the frontal plane, (2) delta wave axis in the frontal plane, (3) the angle between QRS and delta wave axes, (4) the rmR S ratio in lead III, (5) negativity of delta wave in inferior leads, and (6) the rmR S ratio in precordial leads. Results were (1) QRS axis in the frontal plane in the right free wall — range from +15 to −65 ° (−32 ± 19 °); true posteroseptal pathways — range from +30 to −60 ° (−38 ± 22 °); midseptal pathways range from +15 to +60 ° (+49 ± 11 °); anteroseptal pathways range from 0 to +75 ° (+46 ± 22 °); (2) delta wave axis in the right free wall −0 to −60 ° (−32 ± 22 °); true posteroseptal − 0 to −60 ° (−43 ° 18 °); midseptal −0 to +45 ° (+24 ± 15 °), and anteroseptal −0 to +60 ° (+45 ± 17 °); (3) QRS/delta wave axis angle in the right free wall − 7 ± 6 °, true posteroseptal −9 ± 7 °; midseptal − 22 ± 6 °, and anteroseptal accessory pathways − 3 ± 5 °; (p = 0.006); (4) the rmR S ratio lead III was 1 in anteroseptal and equal to 1 in midseptal accessory pathways; (5) delta negativity in ≥2 inferior leads was observed in the right free wall −90%; in true posteroseptal −90%, in midseptal − 0%, and anteroseptal accessory pathways −0% (p rmR S ratio >1 in lead V 2 was right free wall −20%, true posteroseptal −100%, midseptal — 12%, anteroseptal −0% (p rmR S ratio in lead III. A QRS/delta wave axis angle of ≥20 ° and an rmR S ratio equal to 1 in lead III favor a midseptal accessory pathway location.