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Lookup NU author(s): Professor Bob Anderson
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2022. For permissions, please email: journals.permissions@oup.com. The mid-paraseptal region corresponds to the portion of the pyramidal space whose right atrial aspect is known as the triangle of Koch. The superior area of this mid-paraseptal region is also para-Hisian, and is close to the compact atrioventricular node and the His bundle. The inferior sector of the mid-paraseptal area is unrelated to the normal atrioventricular conduction pathways. It is, therefore, a safe zone in which, if necessary, to perform catheter ablation. The middle part of the mid-paraseptal zone may, however, in some patients, house components of the compact atrioventricular node. This suggests the need for adopting a prudent attitude when considering catheter ablation in this area. The inferior extensions of the atrioventricular node, which may represent the substrate for the slow atrioventricular nodal pathway, take their course through the middle, and even the inferior, sectors of the mid-paraseptal region. In this review, we contend that the middle and inferior areas of the mid-paraseptal region correspond to what, in the past, was labelled by most groups as the 'midseptal' zone. We describe the electrocardiographic patterns observed during pre-excitation and orthodromic reciprocating tachycardia in patients with pathways ablated in the middle or inferior sectors of the region. We discuss the modification of the ventriculo-atrial conduction times during tachycardia after the development of bundle branch block aberrancy. We conclude that the so-called 'intermediate septal' pathways, as described in the era of surgical ablation, were insufficiently characterized. They should not be considered the surrogate of the 'midseptal' pathways defined using endocardial catheter electrode mapping.
Author(s): Farre J, Anderson RH, Rubio J-M, Garcia-Talavera C, Sanchez-Quintana D, Bansal R, Lokhandwala Y, Cabrera J-A, Wellens HJJ, Back Sternick E
Publication type: Review
Publication status: Published
Journal: EP Europace
Year: 2022
Volume: 24
Issue: 4
Pages: 662-675
Print publication date: 01/04/2022
Online publication date: 06/01/2022
Acceptance date: 08/11/2021
ISSN (print): 1099-5129
ISSN (electronic): 1532-2092
Publisher: NLM (Medline)
URL: https://doi.org/10.1093/europace/euab294
DOI: 10.1093/europace/euab294
PubMed id: 34999785
