Reproducibility of bipolar endocavitary electrogram measurements at sites of radiofrequency energy delivery in patients with the Wolff-Parkinson-White syndrome.

Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 1998 · Unclear · Low evidence

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UnclearLow evidencePaper 4080

Study snapshot

PublicationJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 1998

Study typeother

Reported directionUnclear

Evidence ratingLow

Abstract

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.

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AI evidence extraction

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Study typeother

Effect directionunclear

PopulationPatients with Wolff-Parkinson-White syndrome undergoing radiofrequency ablation

Sample size28

ExposureNot supplied

Evidence strengthLowConfidence: 74% · Peer reviewed: yes

Main findings

Three independent observers measured four bipolar electrogram intervals at sites of radiofrequency energy delivery in 28 patients. Interobserver reproducibility was low: only 50% of A0V0 intervals had interobserver differences <10 ms, and up to 43% of Va-QRS intervals had differences >30 ms; kappa values were <0.40, indicating poor agreement. The authors conclude that poor reproducibility limits the reliability of bipolar criteria for predicting successful ablation sites.

Outcomes measured

Interobserver reproducibility of bipolar endocavitary electrogram interval measurements (A0V0, AaVa, V0-QRS, Va-QRS)
Interobserver measurement differences (e.g., <10 ms, >30 ms)
Kappa statistic for agreement

Limitations

Frequency, power, or dosimetry of radiofrequency energy delivery not reported
Study evaluates measurement reproducibility rather than health effects of EMF exposure
Only interobserver variability assessed; other sources of variability not described

View raw extracted JSON

{
  "study_type": "other",
  "exposure": {
    "band": null,
    "source": "radiofrequency energy delivery (catheter ablation)",
    "frequency_mhz": null,
    "sar_wkg": null,
    "duration": null
  },
  "population": "Patients with Wolff-Parkinson-White syndrome undergoing radiofrequency ablation",
  "sample_size": 28,
  "outcomes": [
    "Interobserver reproducibility of bipolar endocavitary electrogram interval measurements (A0V0, AaVa, V0-QRS, Va-QRS)",
    "Interobserver measurement differences (e.g., <10 ms, >30 ms)",
    "Kappa statistic for agreement"
  ],
  "main_findings": "Three independent observers measured four bipolar electrogram intervals at sites of radiofrequency energy delivery in 28 patients. Interobserver reproducibility was low: only 50% of A0V0 intervals had interobserver differences <10 ms, and up to 43% of Va-QRS intervals had differences >30 ms; kappa values were <0.40, indicating poor agreement. The authors conclude that poor reproducibility limits the reliability of bipolar criteria for predicting successful ablation sites.",
  "effect_direction": "unclear",
  "limitations": [
    "Frequency, power, or dosimetry of radiofrequency energy delivery not reported",
    "Study evaluates measurement reproducibility rather than health effects of EMF exposure",
    "Only interobserver variability assessed; other sources of variability not described"
  ],
  "evidence_strength": "low",
  "confidence": 0.74,
  "peer_reviewed_likely": "yes",
  "keywords": [
    "radiofrequency ablation",
    "Wolff-Parkinson-White syndrome",
    "bipolar electrogram",
    "endocavitary electrogram",
    "interobserver reproducibility",
    "kappa",
    "electrophysiology"
  ],
  "suggested_hubs": []
}

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AI-extracted fields are generated from the abstract and metadata and may be incomplete or incorrect. This material is for informational purposes and is not medical advice.

Identifiers and source

DOI: 10.1023/a:1009772923689
PubMed: 10027125

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