Abstract
Objectives: This study was designed to characterize the surface electrocardiogram (ECG) of the typical Wolff-Parkinson-White (WPW) syndrome to develop a new algorithm ECG to localize the septal accessory pathways (APs) and to prospectively test the accuracy of the algorithm.
 Methods: We studied 106 patients, in which 65 patients with typical WPW syndrome who had a single antero-grade with the localization of APs identified by successful radiofrequency catheter ablation (RFCA) to develop a new ECG algorithm for the septal AP localization. Then, this algorithm was tested prospectively in 41 patients to compare to the localization of APs by successful ablation by RFCA (gold standard).
 Results: In 65 patients with typical WPW syndrome, we found that the 12-lead ECG parameters such as the transition of the QRS complex, delta wave polarity in V1 lead, delta wave polarity in at least 2/3 inferior leads and ``QRS pattern'' in inferior leads can predict the localization of septal APs with the accuracy ranging from 83.3% to 100%. Then, 41 patients were prospectively evaluated by the new derived algorithm to localize the septal APs with high sensitivity and specificity from 84.6% to 100%.
 Conclusion: 12-lead ECG parameters in typical WPW syndrome are strongly correlated to the septal AP localization, which can be used to develop a new ECG algorithm to localize septal APs with high accuracy.
Highlights
Wolff-Parkinson-White (WPW) syndrome associated with an accessory Atrial Node ECG (AV) connection
We studied 106 patients, in which 65 patients with typical WPW syndrome who had a single antero-grade with the localization of accessory pathway (AP) identified by successful radiofrequency catheter ablation (RFCA) to develop a new ECG algorithm for the septal AP localization
In 65 patients with typical WPW syndrome, we found that the 12-lead ECG parameters such as the transition of the QRS complex, delta wave polarity in V1 lead, delta wave polarity in at least 2/3 inferior leads andQRS pattern'' in inferior leads can predict the localization of septal APs with the accuracy ranging from 83.3% to 100%
Summary
Wolff-Parkinson-White (WPW) syndrome associated with an accessory AV connection (called Kent Bundle). Radiofrequency catheter ablation (RFCA) of the accessory pathway (AP) is required to precisely localize the APs along the mitral and tricuspid annulus (gold standard) 2. 12-lead ECG is the first step to localize AP in patients with WPW syndrome. Some ECG based algorithms have been published to predict the location of the septal APs 1–4. Many studies showed that it was more difficult to ablate in this area compared to other locations, because the septal area is a complex anatomic structure where four cardiac chambers and the coronary sinus come in close proximity. The purpose of this study was to analyze the 12-lead ECG of septal APs successfully localized by RFCA to develop a new ECG algorithm using simple parameters and to test this algorithm to predict APs location prospectively
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