An Accurate Stepwise Electrocardiographic Algorithm for localization of Accessory Pathways in Patients With Wolff-Parkinson-White Syndrome from a Comprehensive Analysis of Delta Waves and R/S Ratio During Sinus Rhythm⋆
Section snippets
Methods
Patients: In all, 393 consecutive patients with Wolff-Parkinson-White syndrome were referred for electro-physiologic study and radiofrequency ablation. Sixteen patients with multiple accessory pathways and 8 with unsuccessful radiofrequency ablation were excluded. Three hundred sixty-nine patients who were proved to have a single anterogradely conducting accessory pathway by successful radiofrequency ablation formed the subject of this study. There were 219 men and 150 women (mean age 48 ± 10
Results
Accessory pathway location: The accessory pathway location in the initial 182 patients is shown in Figure 2.
Eledrocardiographic characteristics: Both observers agreed that electrocardiograms for right anteroseptai and right anterior pathways were very similar and could not be differentiated, as were right posterior and right posterolateral pathways, left posterior and left posterolateral pathways, and left lateral and left anterolateral pathways. They were designated as right anteroseptal/right
Discussion
By a comprehensive analysis of delta wave polarity and R/S ratio, and a new definition of the initial 60 ms to represent delta wave polarity in V1, we developed an accurate ECG algorithm to predict the location of an accessory pathway in patients with Wolff-Parkinson-White syndrome during sinus rhythm. The algorithm was entirely based on the results from radiofrequency ablation and was featured by its easiness to be applied, because only 4 ECG leads and 4 steps were required, and the same ECG
Acknowledgment
We thank Benjamin Ing-Tiau Kuo, MD, for his assistance in statistical analysis.
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This study was supported in part by Grants NSC 81–0412-B075–525, 82–0115-B075–110, and 83-0412-B075-028 from the National Science Council and the Academia Sinica, Taipei, Taiwan, Republic of China.