Abstract
Accessory pathway (AP) ablation is a standard procedure for the treatment of Wolff-Parkinson-White syndrome (WPW). 12-lead electrocardiogram (ECG) based delta wave analysis is essential for predicting ablation sites. Previous algorithms have shown to be complex, time-consuming and often unprecise because of variable anatomical heart axis especially in children. Our study aimed to retrospectively develop and prospectively validate a new, simple ECG-based algorithm considering the patients’ heart axis allowing an exact localization of APs in patients undergoing ablation for WPW. Our study included 109 patients undergoing ablation of a single manifest AP due to WPW between 2013 and 2021. For the exact determination of delta wave axis profound analyses of 12-lead ECGs were performed. The new algorithm (EASY WPW) includes a 2-step (left side) and 3-step-identification (right side) of the AP region, respectively. First we validated our algorithm comparing its efficacy to two established ones (Pambrun and Arruda). Then the new algorithm was tested also prospectively focusing on the accuracy of pathway region prediction. In all patients (29±18 years old, 45% female) pathway ablation was performed successfully. 12-lead ECG-based prediction of accurate AP localization using EASY-WPW was correct in 102 patients (94%) (sensitivity 93%, specificity 99%, PPV 97%, NPV 99%). Our algorithm was particularly useful in correctly localizing antero-septal/-lateral (sensitivity and specificity 100%) and posteroseptal (sensitivity 100%, specificity 91%) AP in proximity to the tricuspid valve. The accuracy (percentage of patients with an exact prediction of AP localization) of EASY-WPW was superior compared to the Pambrun (94% vs. 84%, p=0.049*) and the Arruda algorithm (94% vs. 75%, p<0.001*). A subgroup analysis of children (n=40, 11±4 years old, 45% female) revealed significant superiority to the Arruda algorithm (p=0.004*). Our novel 12-lead ECG-based algorithm enables reliable and accurate pre-interventional ablation site determination in WPW patients. Only two steps are necessary to locate left-sided AP and three steps to determine right-sided AP. This can be done with the help of a simple flow chart or, in the future, with the help of an app.
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