Localization of accessory pathways according to AP Fitzpatrick ECG criteria in patents with Wolff-Parkinson-White Syndrome in our population

The objective of this prospective study was to localize the accessory pathways [AP] in patients with Wolff Parkinson White syndrome [WPW] using algorithm laid down by AP Fitzpatrick, in our population. 500 consecutive patients with the most pre-excited 12 lead ECG in sinus rhythm visiting emergency department were analyzed. Delta wave frontal plane vector, polarity in VI, height in leads I, II and III and sum of delta waves polarities in II, III and aVF. R wave size in leads I, II, III, VI; R/S ratio in leads I, aVL, V1; S wave size in V1 and QRS axis and duration; QRS horizontal plane transition zone were the main EGG variables used to localize the accessory pathway. The most discriminative characteristics were combined to form the following steps. Step 1, location of the transition lead [R and S waves are equiphasic] in the chest leads and R>S wave by > or < 1mV, this divides the pathways into right and left sided. Step 2, sum of delta waves polarities in leads II, III and aVF, this divides the pathways into Septal or lateral locations. Among 500 patients, 409[81.8%] patients had WPW syndrome while 91[18.2%] patients had WPW pattern, Mean age of study population was 34.23 +/- 12.5 years. There were 327[65.4%] males and 173[34.6%] females with a male to female ratio of 3:1. Three hundred [60%] patients had right sided accessory pathways while 190[38%] had left sided AP. Among right sided AP Right posteroseptal pathway was the most common location 87[28.8%] comprising [17.7%] of total population. Left antero-lateral pathway was the most common location not only among left sided pathways 95[50%] but also in total study population [19.4%]. The AP Fitzpatrick ECG criteria for localization of the accessory pathways on surface ECG is an excellent non invasive method for determination of the site of accessory pathway with very high sensitivity, specificity and predictive accuracy. It is an excellent tool before planning invasive electrophysiological study in WPW syndrome

Mid-term results of endarterectomy in advanced coronary artery disease

To compare the angiographic results of patency of endarterectomized vessels vs non endarterectomized vessels and their associated grafts after one year of coronary artery bypass grafting. Study was conducted at the Cardiology Department, Punjab Institute of Cardiology, Jail Road, Lahore from 1st October 2004 till 30th July 2006. Consecutive patients were included in the study after undergoing coronary artery bypass grafting and coronary endarterectomy in the hospital. All the patients included in the study were followed up prospectively after 1, 3, 6, 9 and 12 months of coronary artery bypass grafting and angiographic studies were performed at the end of 1 year of follow-up. The mean age of the study population was 55.8 +/- 10.1 years. There were 64 [85.3%] males and 11 [14.7%] females. Hypertension and family history of ischemic heart disease both were present in 40 [53.3%] patients. Diabetes mellitus was present in 23 [30.7%] patients while 38 [50.6%] patients were smokers. A total of 266 grafts were applied to these 75 patients. Of these 181 grafts wee applied to non-endarterectomized vessels and 85 to endarterectomized vessels. Follow-up angiography revealed 6 [3.3%] blocked grafts in a total of 181 non endarterectomized vessels. Of the 85 endarterectomized vessels, 4 [4.7%] grafts with their parent vessels were blocked. Graft patency was not significantly different between endarterectomized and non-endarterectomized grafts [95.3% vs 96.6%] p<0.11. All patients receiving LIMA to LAD had patent grafts at the end of one year. The blocked grafts were all SVGs