Development and evaluation of 12-lead electrocardiogram in the left free wall of accessory pathway localization in patients with typical Wolff-Parkinson-White syndrome

Dong Van Tran,Khanh Quoc Pham,Si Dung Chu

doi:10.15419/bmrat.v5i11.502

Abstract

Objectives: This study was designed to characterize 12-lead electrocardiogram (ECG) for localization of the left free wall lateral accessory pathway (AP) in patients with typical Wolff-Parkinson-White (WPW) syndrome, to develop a new algorithm ECG for localizing APs, and to test the accuracy of the algorithm prospectively. Method: We studied 129 patients; 84 patients had typical WPW syndrome with single anterograde AP identified by successful radiofrequency catheter ablation (RFCA), and were enrolled to build a new ECG algorithm for localizing left free wall APs. Then, the algorithm was tested prospectively in 45 patients and compared with the location of APs successfully ablated by RFCA. Results: We found that the 12-lead ECG parameters in typical WPW syndrome, such as delta wave polarity in V1, R/S ratio in V1, transition of the QRS complex, and delta wave polarity in inferior, lead to diagnosis and localization of APs, with highest accuracy predicted from 74.5%-100%, and for development of a new ECG algorithm. From the 45 patients who were prospectively evaluated by the newly derived algorithm for the left free wall pathways, the sensitivity and specificity was high (from 75-100%). Conclusion: The 12-lead ECG parameters in typical WPW syndrome are closely related to left free wall AP localization and can be used to develop a new ECG algorithm by the parameters above. Moreover, the new ECG algorithm can predict the location of APs with high accuracy.

Highlights

Wolff-Parkinson-White syndrome (WPW) is a form of ventricular preexcitation in which part of the ventricular myocardium is depolarized early by one or more accessory pathways (APs) that bypass the atrioventricular (AV) node, establishing a direct link between the atrium and the ventricle
We studied 129 patients; 84 patients had typical WPW syndrome with single anterograde AP identified by successful radiofrequency catheter ablation (RFCA), and were enrolled to build a new ECG algorithm for localizing left free wall APs
We found that the 12-lead ECG parameters in typical WPW syndrome, such as delta wave polarity in V1, R/S ratio in V1, transition of the QRS complex, and delta wave polarity in inferior, lead to diagnosis and localization of APs, with highest accuracy predicted from 74.5%-100%, and for development of a new ECG algorithm

Summary

Introduction

Wolff-Parkinson-White syndrome (WPW) is a form of ventricular preexcitation in which part of the ventricular myocardium is depolarized early by one or more accessory pathways (APs) that bypass the atrioventricular (AV) node, establishing a direct link between the atrium and the ventricle (called Kent Bundle). The 12-lead electrocardiogram (ECG) is characterized by a shortened PR, prolonged QRS, and Delta wave [1,2]. Arrhythmias are frequent in WPW syndrome patients due to paroxysmal supraventricular tachycardia (PSVT), atrial fibrillation (AF), etc.; the most dangerous are ventricular fibrillation and sudden death [1,2]. Radiofrequency catheter ablation (RFCA) of APs requires precise localization of the AP along the mitral and tricuspid annulus (gold standard) 2. The 12-lead ECG is the first step for localization of AP in patients with WPW syndrome, up to now. The data obtained from the ECG parameters can be helpful in planning and shortening the RFCA procedure and fluoroscopy time 2

Objectives

Results

Discussion

Conclusion