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PubMed1996

Determinants of success and failure of EMLA.

Although EMLA is known to be an effective topical anesthetic, its rate of success is unknown. Indeed, researchers have suggested that EMLA may fail with young and apprehensive children. Therefore, the objectives of this study were to assess EMLA's rate of success as well as factors which predict success. A double-blind, placebo-controlled design was utilized. The sample included 258 children and adolescents aged 5-18 years who were having venipuncture or intravenous (i.v.) cannulation. After having their anxiety assessed, subjects were randomly assigned to have EMLA or placebo applied over the procedure site for 90 min. The visual analogue scale was used to assess pain caused by removal of the semi-permeable dressing and by the procedure. Other information that was collected included: duration of drug application, interval between drug removal and procedure, skin changes at bandage and drug sites and rated difficulty of the procedure. EMLA was successful 84% of the time for venipuncture and 51% of the time for i.v. cannulation. Factors which predicted success of EMLA included type of procedure, duration of drug application and anxiety. EMLA was less successful for i.v. cannulation compared to venipuncture even with duration of drug application controlled. Those who had a poor outcome were more anxious than those with a good outcome. Age of child was not a factor. Strategies for improving efficient use of EMLA were recommended.

Administration, Topical↗
PubMed1991

Clinical and angiographic determinants of primary coronary angioplasty success. M-HEART Investigators.

Clinical and anatomic determinants of the initial success of percutaneous transluminal coronary angioplasty were prospectively evaluated in 826 patients enrolled in the Multi-Hospital Eastern Atlantic Restenosis Trial (M-HEART). The 639 men and 187 women ranged in age from 31 to 85 years. Successful angioplasty (residual stenosis less than 50% and no major complications) was achieved in 886 (88.6%) of 1,000 lesions. Success rates were uniform among the eight individual centers. Outcome was not influenced by gender, age or other clinical features, including severity and duration of angina, prior myocardial infarction, rest pain, transient ST segment elevation, history of smoking or diabetes. In contrast, procedural outcome was significantly associated with lesion-specific angiographic factors. Stenoses 60% to 74%, 75% to 89%, 90% to 99% and 100% were associated with success rates of 96%, 90%, 84% and 69%, respectively (p less than 0.001). Angioplasty was less successful in calcified than in noncalcified lesions (82% versus 90%, p less than 0.01), in thrombotic than in nonthrombotic lesions (82% versus 90%, p less than 0.05) and in lesions in the right coronary artery than in other vessels (84% versus 90%, p less than 0.01). Outcome was not related to other anatomic variables, including lesion location (proximal versus distal), vessel size, eccentricity, stenosis length or translesional gradient. By multivariate logistic regression, preangioplasty percent stenosis, right coronary artery location and lesion calcification were demonstrated to be significant independent predictors of angioplasty success. Alternative clinical and angiographic variables did not contribute to this regression model.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed2006

Factors affecting the clinical success of screw implants used as orthodontic anchorage.

INTRODUCTION: The purposes of this study were to examine the success rates and find factors affecting the clinical success of screw implants used as orthodontic anchorage. METHODS: Eighty-seven consecutive patients (35 male, 52 female; mean age, 15.5 years) with a total of 227 screw implants of 4 types were examined. Success rates during a 15-month period of force application were determined according to 18 clinical variables. RESULTS: The overall success rate was 91.6%. The clinical variables of screw-implant factors (type, diameter, and length), local host factors (occlusogingival positioning), and management factors (angle of placement, onset and method of force application, ligature wire extension, exposure of screw head, and oral hygiene) did not show any statistical differences in success rates. General host factors (age, sex) had no statistical significance. Mobility, jaw (maxilla or mandible), and side of placement (right or left), and inflammation showed significant differences in success rates. Mobility, the right side of the jaw, and the mandible were the relative risk factors in the logistic regression analysis when excluding mobility, inflammation around the screw implants was added to the risk factors. CONCLUSIONS: To minimize the failure of screw implants, inflammation around the implant must be controlled, especially for screws placed in the right side of the mandible.

Adolescent↗
PubMed2004

Diet-controlled gestational diabetes mellitus does not influence the success rates for vaginal birth after cesarean delivery.

OBJECTIVE: We sought to determine whether women with diet-controlled gestational diabetes mellitus who attempt vaginal birth after cesarean delivery are at increased risk of failure, when compared with their non-diabetic counterparts. STUDY DESIGN: We identified 13,396 women who attempted vaginal birth after cesarean delivery among 25,079 pregnant women with a previous cesarean delivery who were delivered between 1995 and 1999 at 16 community and university hospitals. Analysis was limited to 9437 women without diabetes mellitus and 423 women with diet-controlled diabetes mellitus who attempted vaginal birth after cesarean delivery with a singleton gestation and 1 previous low-flap cesarean delivery. Data that were collected by trained abstractors, included demographics, medical history, and both pregnancy and neonatal outcomes. Multivariable logistic regression analysis was performed to determine an adjusted odds ratio for vaginal birth after cesarean delivery success among women with diet-controlled gestational diabetes compared with women with no diabetes mellitus. We controlled for birth weight, maternal age, race, tobacco, chronic hypertension, hospital settings, labor management, and obstetric history. RESULTS: Forty-nine percent of the women with gestational diabetes mellitus and 67% of the women with no diabetes mellitus attempted vaginal birth after cesarean delivery. The success rate for attempted vaginal birth after cesarean delivery among gestational diabetic women was 70%, compared with 74% for non-diabetic women. We found that gestational diabetes mellitus is not an independent risk factor for vaginal birth after cesarean delivery failure. The relative risk for vaginal birth after cesarean delivery success in women with gestational diabetes mellitus compared with women without gestational diabetes mellitus was 0.94 (95% CI, 0.87-1.00). After an adjustment was made for confounding, the odds ratio for success with gestational diabetes mellitus was 0.87 (95% CI, 0.68-1.10). CONCLUSION: Women with diet-controlled gestational diabetes mellitus who were carrying singleton fetuses who had no more than 1 previous low flap cesarean delivery should be counseled that their disease does not decrease their chances for a successful vaginal birth after cesarean delivery. Among diet-controlled diabetic women, the overall success rate for vaginal birth after cesarean delivery remains acceptable, and attempted vaginal birth after cesarean delivery should not be discouraged solely on the basis of gestational diabetes mellitus.

Adult↗
PubMed2006

Manual rotation of the fetal occiput: predictors of success and delivery.

OBJECTIVE: The purpose of the study was to define predictors of successful rotation and rate of cesarean delivery after manual rotation of the fetal occiput from occiput posterior or transverse position. STUDY DESIGN: A retrospective cohort study comprised patients who underwent a trial of manual rotation of the fetal occiput from occiput posterior or occiput transverse position. Successful rotation was defined as delivery in the occiput anterior position. We examined maternal, fetal, and labor characteristics as predictors of both fetal position at delivery and cesarean delivery. RESULTS: Multiparity (odds ratio, 2.5; 95% CI, 1.5-3.8) and maternal age < 35 years (odds ratio, 2.0; 95% CI, 1.1-3.4) were associated with successful manual rotation of the fetal occiput. After successful rotation, the cesarean delivery rate was 2%, compared with 34% if the rotation failed (P < .001). Asian ethnicity, nulliparity, age > 35 years, labor induction, and epidural usage were associated with higher rates of cesarean delivery. CONCLUSION: After successful manual rotation of the fetal occiput, women had lower cesarean delivery rates than women with unsuccessful rotations. Multiparity and maternal age of < 35 years were associated with more successful rotations.

Adult↗
PubMed2006

Inferring strategies for disseminating physical activity policies, programs, and practices from the successes of tobacco control.

Efforts at reducing tobacco use in the United States and Canada over the last half century have been amazingly successful. This article examines those efforts in order to identify policies, programs, and practices found useful in tobacco control that might be usefully disseminated to world populations to improve rates of physical activity. Tobacco-control activities began with efforts to influence the individual smoker through public education and counter-advertising. Increasing awareness of the addictive properties of tobacco, industry efforts to manipulate those properties, and to target youth with aggressive advertising, fueled public outrage that supported additional policy changes to include community interventions, legal actions, and restraints against the tobacco industry. The article first examines ways to view the process of transferring knowledge from one enterprise (reducing tobacco consumption) to another (increasing physical activity). Several theories of knowledge generalization and dissemination are explored: transfer, knowledge utilization, application, diffusion, and implementation. The second section identifies the dissemination of tobacco control by means of brief health behavior-change interventions for smoking cessation that have been successfully integrated into primary clinical care. The question of whether similar strategies can be successfully disseminated to increase physical activity is examined in detail. The article then moves on to look at the success of arguably the most successful program in the world at achieving a reduction in tobacco control-the State of California. Finally, we compare and contrast some of the lessons as they have played out in another national context-Canada. In the concluding section, some lessons are identified that we believe may be successfully utilized in societal attempts to increase physical activity in world populations.

Canada↗
PubMed2004

Relation of clinical success in coronary brachytherapy to dose.

Intravascular brachytherapy is the primary treatment for coronary in-stent restenosis. Variations in dose in the treated artery may represent a potential cause of treatment failure. We compared dose distributions in patients who had developed recurrent restenosis (treatment failure) with those in patients who remained event free at 9 months (treatment success). We followed 140 patients who were receiving brachytherapy for in-stent restenosis with 4 radiation delivery devices to identify treatment failures and successes. Through a nested case-control construct, treatment failures (n = 14) were compared 1:2 with treatment successes (n = 28) matched by radiation delivery system and in-stent restenosis lesion pattern. The dose absorbed by 90% of the artery encompassed by the external elastic membrane (D(90)EEM) was calculated by applying intravascular ultrasound at 2-mm intervals along the treated lesion. Dose calculations were performed using dose kernel integration techniques generated from Monte Carlo simulations. The mean minimum D(90)EEM in treatment failures was 7.46 +/- 1.98 Gy, and that in treatment successes was 8.87 +/- 1.13 Gy (p = 0.007). Using a minimum dose threshold of 8.4 Gy, a minimum D(90)EEM <or=8.4 Gy occurred in 13 patients (93%) whose treatment failed but only in 9 patients (32%) whose treatment was a success (p <or=0.001). No confounding variables were found to be statistically significant between treatment failures and successes. In conclusion, current brachytherapy dose prescriptions allow for inter- and intralesion variations in dose. Arteries that receive <or=8.4 Gy at any point along the external elastic membrane are more likely to result in treatment failures. Dosimetry guided by intravascular ultrasound may be critical to ensure adequate dose delivery and outcomes.

Adult↗
PubMed2006

Real-time ultrasonographically-guided internal jugular vein catheterization in the emergency department increases success rates and reduces complications: a randomized, prospective study.

STUDY OBJECTIVE: We compare real-time ultrasonographic guidance and the traditional landmark technique for the insertion of internal jugular vein catheters in an emergency department (ED) setting. METHODS: This was a prospective, randomized, clinical study performed in a tertiary ED between August 2003 and May 2005 on patients requiring central venous access. Ultrasonographically guided catheters were inserted under real time using the Sonosite ultrasonographic system with a 10 to 5 MHz 38-mm linear array transducer. Standardized data were collected on operator experience, method of insertion, reason for central venous access, and comorbidities. Outcome measures included successful insertion of an internal jugular vein catheter, number of attempts, access times, and complications. RESULTS: One hundred thirty patients were enrolled. Cannulation of the internal jugular vein was successful in 61 of 65 patients (93.9%) using ultrasonography and in 51 of 65 patients (78.5%) using the landmark technique, a significant difference of 15.4% (P=.009, 95% confidence interval [CI] 3.8% to 27.0%). Fifty of 61 (82.0%) of the successful ultrasonographically guided catheters were inserted on the first attempt compared with 36 of 51 (70.6%) of the successful landmark catheters. Mean access times to venipuncture and successful insertion were 138 and 281 seconds by ultrasonographic guidance and 132 and 271 seconds by the landmark technique. There was a 10.8% complication rate, with 11 complications (16.9%) in the landmark group and 3 (4.6%) in the ultrasonographic group, a difference of 12.3% (95% CI 1.9% to 22.8%). CONCLUSION: Ultrasonographically guided internal jugular vein catheterization in the ED setting was associated with a higher successful insertion rate and a lower complications rate.

Adult↗
PubMed2005

Effects of copper on the fertilization success of the soft coral Lobophytum compactum.

This study provides the first information on the effects of various concentrations of copper on the fertilization success of gametes from the soft coral Lobophytum compactum. Two experiments were conducted to determine the effect of copper on fertilization success during the mass coral spawning in 2004 on the Great Barrier Reef (GBR). The results from the first experiment showed a surprising resistance to copper with control treatments showing 90% fertilization compared to 65% fertilization in measured copper concentrations up to 132 microg/L. Copper concentrations of 69 microg/L and higher resulted in significantly reduced fertilization success when compared to the controls. Copper doses were increased in experiment 2 and the EC50 value for copper effects on fertilization success was 261 microg/L (208-328 microg/L, 95% confidence limits). In this follow-up experiment, fertilization success was significantly lower than the controls after exposure to copper concentrations of 117 microg/L and above. The EC50 value reported here is much higher than those found in the literature on fertilization experiments conducted on hard coral gametes and also for the fertilization success of other marine organisms, including sea urchins, oysters and fish.

Animals↗
PubMed2006

Investigator beliefs and reported success in recruiting minority participants.

PURPOSE: Attaining adequate minority participation in clinical trials has been challenging and limited by the lack of data on the role that investigator perceptions play in minority recruitment. We sought to determine what investigator and study factors were associated with investigators' reported success in recruiting minority populations in research. METHODS: Principal investigators (PIs) who conducted clinical research funded by the National Heart, Lung and Blood Institute in 2001 were surveyed about their success in recruiting minority populations, perceptions about the importance of minority recruitment, use of recruitment strategies, and barriers to minority recruitment. Logistic regression was used to identify factors associated with PIs' reports of success in minority recruitment. RESULTS: A total of 440 PIs completed the survey about minority recruitment. PIs who agreed more strongly about the importance of minority inclusion in their research reported being more successful in minority recruitment. PIs who reported midstream modifications to their recruitment strategies to increase minority participation and those who reported more barriers reported less success in recruiting minority populations. CONCLUSION: PIs' reports of success in recruiting ethnic/racial minority populations for research are associated with the value investigators place on inclusion of minority participants in their research. PIs' perceptions should be considered in minority recruitment efforts as they may influence minority participation rates.

Attitude of Health Personnel↗
PubMed2005

What does an intermediate success rate mean? An analysis of a Piagetian liquid conservation task in the great apes.

The study investigates what an intermediate success rate means in bonobos, chimpanzees, and orangutans. Apes participated in liquid conservation experiments where they had to track the larger of two different quantities of juice after various kinds of transformations [Suda, C., & Call, J. (2004). Piagetian liquid conservation in the great apes (Pan paniscus, Pan troglodytes, and Pongo pygmaeus). Journal of Comparative Psychology, 118, 265-279). When making a decision, apes sometimes demonstrated hesitant behavior, concurrently pointing to both alternatives or successively changing their choice. Moderately successful apes showed more hesitation than highly successful or unsuccessful apes. The results are consistent with the cognitive conflict model: The experiments created a higher degree of cognitive conflict on moderately successful apes than on very successful or unsuccessful apes. This indicates that an intermediate performance reflects the joint operation and potential conflict between two different cognitive strategies (identity and appearance) inherent to the Piagetian conservation task.

Analysis of Variance↗
PubMed2005

A training course for the Israeli phase I written board examination in internal medicine increases the success rate of foreign graduate physicians.

BACKGROUND: Foreign graduate residents in internal medicine perform poorly on the Israeli phase I written board examination as compared to local graduates from Israeli medical schools. The aim of this study was to determine the effect of a preparatory course, aimed at foreign graduates, on their success rate in the Israeli phase I written board examination in internal medicine. METHODS: The preparatory course consisted of seven 4-h weekly meetings that took place 3 months before the board examination. Participants were divided into two classes, each containing approximately 35 residents. Each meeting was dedicated to two fields of internal medicine and consisted of a multiple-choice examination, followed by a guided discussion with a senior physician. A pre-test was given at the end of the course and its results were compared to those of the official examination. Residents who took the official examination but who did not participate in the course served as controls. RESULTS: The combined 2-year (1999-2000) success rate on the official phase I board examination of foreign graduates who took the course was significantly higher than that of controls: 41.7% vs. 30.4%, respectively (p<0.019). The results of the course pre-test were highly predictive of the success on the board examination (r=0.481, p<0.01). The course did not significantly improve the success rate of the Israeli graduates. CONCLUSION: A short, focused, preparatory course significantly increases the success rate of foreign graduate residents on the Israeli phase I written board examination in internal medicine. Performance in the course is highly predictive of the success rate on the official board examination.

Journal Article↗
PubMed2004

Prediction of successful vaginal delivery in women undergoing external cephalic version at term for breech presentation.

OBJECTIVE: The aim of this study is to evaluate the clinical and sonographic predictors of ultimate successful vaginal delivery in women undergoing external cephalic version. STUDY DESIGN: The study population consisted of women with external cephalic version performed at or after 36 weeks of gestation. They were randomized into group A or B, each consisted of half of the total study population. Logistic regression was performed on group A to identify the significant independent variables in predicting successful cephalic vaginal delivery, which were used to construct a prediction model. The derived regression model was then tested in group B to assess its accuracy. RESULTS: The study included 407 pregnancies. Maternal weight (kg) at the time of version, maternal height (cm), multiparity, engagement of fetal presenting part, and fetal head palpable were significant independent variables of successful version and vaginal delivery (regression coefficients are: -0.084, 0.085, 1.752, -1.271, and 0.725, respectively). A prediction model was constructed based on these independent variables. The weighted average of the overall accuracy in predicting success or failure of version and vaginal delivery was 70.9%. The regression model was then applied to study group B. Using 0.50 as the cutoff value, the sensitivity, specificity, positive, and negative predictive values were 75.4, 58.8, 73.7, and 61.0%, respectively. CONCLUSION: A regression model constructed based on clinical variables failed to provide an accurate predictive tool of successful external cephalic version and vaginal delivery. However, in women who are equivocal about external cephalic version, a high prediction of success would be encouraging.

Adult↗
PubMed2005

Age as a limiting factor for successful sperm retrieval in patients with nonmosaic Klinefelter's syndrome.

OBJECTIVE: To determine factors affecting successful sperm retrieval by testicular sperm extraction in patients with nonmosaic Klinefelter's syndrome. DESIGN: Medical record analysis for nonmosaic Klinefelter's syndrome patients who underwent testicular sperm extraction. SETTING: Three university-based tertiary centers. PATIENT(S): Fifty-one patients with nonobstructive azoospermia related to nonmosaic Klinefelter's syndrome. INTERVENTION(S): Testicular sperm extraction. MAIN OUTCOME MEASURE(S): Correlation of patient characteristics; serum concentrations of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone (T); as well as testicular volume with success in testicular sperm extraction. RESULT(S): We succeeded in obtaining spermatozoa in 26 patients and failed in 25. Levels of LH, FSH, and T and testicular volume did not differ between patient groups defined by success and failure. Median ages for successful and failed testicular sperm extraction were 31 and 38 years, respectively (statistically significant difference). When we analyzed success rates of testicular sperm extraction between two patient groups (<35 and > or =35 years old), the percentage of successful recovery of spermatozoa decreased after the age of 35 years (statistically significant difference). CONCLUSION(S): Testicular sperm extraction should be recommended before the critical age of 35 years.

Adult↗
PubMed2006

A prospective, randomized, placebo-controlled trial of transdermal glyceryl trinitrate in ERCP: effects on technical success and post-ERCP pancreatitis.

BACKGROUND: Despite the recent improvement in techniques and patient selection, post-ERCP pancreatitis remains the most frequent and dreaded complication of ERCP. Recent studies suggest that pretreatment with glyceryl trinitrate (GTN) may prevent post-ERCP pancreatitis and improve cannulation success. OBJECTIVE: To evaluate the effect of transdermal GTN on ERCP cannulation success and post-ERCP pancreatitis. DESIGN: Prospective, double-blind, placebo-controlled trial. SETTING: Tertiary referral university hospital. PATIENTS: A total of 318 patients (mean age 62 years, 61% women) were randomized to either active (n = 155) or placebo (n = 163) arms. INTERVENTIONS: Active patch (GTN) versus placebo patch. MAIN OUTCOME MEASUREMENTS: Cannulation time and success. Post-ERCP pancreatitis rates. RESULTS: There was no significant difference between the active or placebo arms for the following: successful initial cannulation (96.8% vs 98.8%), deep cannulation (96.1% vs 98.8%), time to successful cannulation, use of guidewire (27% vs 25%) or needle knife (13% vs 13%), and post-ERCP pancreatitis (7.4% of placebo patients and 7.7% active patients). Multivariate analysis identified women, younger patients, pancreatogram, number of attempts on papilla, and poor pancreatic-duct emptying after opacification as risk factors for post-ERCP pancreatitis. Transdermal GTN did not reduce post-ERCP pancreatitis in any of the identified high-risk groups. CONCLUSIONS: Transdermal GTN did not improve the rate of success in ERCP cannulation or prevent post-ERCP pancreatitis in either average or high-risk patient groups.

Administration, Cutaneous↗
PubMed2005

Health information systems: failure, success and improvisation.

BACKGROUND AND PURPOSE: The generalised assumption of health information systems (HIS) success is questioned by a few commentators in the medical informatics field. They point to widespread HIS failure. The purpose of this paper was therefore to develop a better conceptual foundation for, and practical guidance on, health information systems failure (and success). METHODS: Literature and case analysis plus pilot testing of developed model. RESULTS: Defining HIS failure and success is complex, and the current evidence base on HIS success and failure rates was found to be weak. Nonetheless, the best current estimate is that HIS failure is an important problem. The paper therefore derives and explains the "design-reality gap" conceptual model. This is shown to be robust in explaining multiple cases of HIS success and failure, yet provides a contingency that encompasses the differences which exist in different HIS contexts. The design-reality gap model is piloted to demonstrate its value as a tool for risk assessment and mitigation on HIS projects. It also throws into question traditional, structured development methodologies, highlighting the importance of emergent change and improvisation in HIS. CONCLUSIONS: The design-reality gap model can be used to address the problem of HIS failure, both as a post hoc evaluative tool and as a pre hoc risk assessment and mitigation tool. It also validates a set of methods, techniques, roles and competencies needed to support the dynamic improvisations that are found to underpin cases of HIS success.

Information Systems↗
PubMed2006

Information system support as a critical success factor for chronic disease management: Necessary but not sufficient.

UNLABELLED: Improvement of chronic disease management in primary care entails monitoring indicators of quality over time and across patients and practices. Informatics tools are needed, yet implementing them remains challenging. OBJECTIVE: To identify critical success factors enabling the translation of clinical and operational knowledge about effective and efficient chronic care management into primary care practice. DESIGN: A prospective case study of positive deviants using key informant interviews, process observation, and document review. SETTING: A chronic disease management (CDM) collaborative of primary care physicians with documented improvement in adherence to clinical practice guidelines using a web-based patient registry system with CDM guideline-based flow sheet. PARTICIPANTS: Thirty community-based physician participants using predominantly paper records, plus a project management team including the physician lead, project manager, evaluator and support team. ANALYSIS: A critical success factor (CSF) analysis of necessary and sufficient pathways to the translation of knowledge into clinical practice. RESULTS: A web-based CDM 'toolkit' was found to be a direct CSF that allowed this group of physicians to improve their practice by tracking patient care processes using evidence-based clinical practice guideline-based flow sheets. Moreover, the information and communication technology 'factor' was sufficient for success only as part of a set of seven direct CSF components including: health delivery system enhancements, organizational partnerships, funding mechanisms, project management, practice models, and formal knowledge translation practices. Indirect factors that orchestrated success through the direct factor components were also identified. A central insight of this analysis is that a comprehensive quality improvement model was the CSF that drew this set of factors into a functional framework for successful knowledge translation. CONCLUSIONS: In complex primary care settings environment where physicians have low adoption rates of electronic tools to support the care of patients with chronic conditions, successful implementation may require a set of interrelated system and technology factors.

British Columbia↗
PubMed2005

Outflow tract tachycardia with R/S transition in lead V3: six different anatomic approaches for successful ablation.

OBJECTIVES: The aim of this study was to analyze different anatomic mapping approaches for successful ablation of outflow tract tachycardia with R/S transition in lead V(3). BACKGROUND: Idiopathic ventricular tachycardia can originate from different areas in the outflow tract, including the right and left ventricular endocardium, the epicardium, the pulmonary artery, and the aortic sinus of Valsalva. Although electrocardiographic criteria may be helpful in predicting the area of origin, sometimes the focus is complex to determine, especially when QRS transition in precordial leads is in V(3). METHODS: We analyzed surface electrocardiograms of 33 successfully ablated patients with outflow tract tachycardia: 20 from the right ventricular outflow tract (RVOT) and 13 from different sites. The R/S transition was determined, and the different anatomic approaches needed for successful catheter ablation were studied. RESULTS: Overall, R/S transition in lead V(3) was present in 19 (58%) of all patients. In these patients, mapping was started and successfully completed in the RVOT in 11 of 19 (58%) patients. The remaining eight patients with R/S transition in lead V(3) needed five additional anatomic accesses for successful ablation: from the left ventricular outflow tract (n = 3), aortic sinus of Valsalva (n = 2), coronary sinus (n = 1), the epicardium via pericardial puncture (n = 1), and the trunk of the pulmonary artery (n = 1), respectively. CONCLUSIONS: A R/S transition in lead V(3) is common. In patients with outflow tract tachycardia with R/S transition in lead V(3), a stepwise endocardial and epicardial mapping through up to six anatomic approaches can lead to successful radiofrequency catheter ablation.

Adult↗