Key result
Epicardial mapping in patients with Wolff-Parkinson-White syndrome showed the site of pre-excitation correlated with the 10 msec VCG vector in 15 patients and 20 msec ECG vector in 29 patients.
Why the study?
Does the spatial position of initial depolarization forces on ECG/VCG correlate with the anatomical location of the accessory pathway in patients with Wolff-Parkinson-White syndrome?
Observational (n=34)
Does the spatial position of initial depolarization forces on ECG/VCG correlate with the anatomical location of the accessory pathway in patients with Wolff-Parkinson-White syndrome?
The initial 10-20 msec forces on VCG and ECG can reliably predict the anatomical location of the accessory pathway in Wolff-Parkinson-White syndrome.
Early vectors may aid pathway localization in WPW; challenges V1-based criteria but leaves open need for validation.
The epicardial activation sequence of 34 patients with the Wolff-Parkinson-White syndrome was determined. Epicardial pre-excitation occurred at a spectrum of sites over either the free wall of the left or right ventricle or in a paraseptal region, always adjacent to the atrioventricular rings. The site of pre-excitation was related to the spatial position of the 10 msec vector of the vectorcardiogram (VCG) in 15 patients and the 20 msec vector of the electrocardiogram (ECG) in 29 patients with a single accessory pathway. All patients whose 20 msec vector (ECG) was directed to the right had accessory pathways which caused epicardial breakthrough over the free wall of the left ventricle. When the 20 msec vector (ECG) was to the left and inferior, epicardial pre-excitation was over either the right ventricular free wall or in the region of the pulmonary outflow tract. Superior location of the initial forces, especially the 10 msec vector (VCG), strongly suggested the presence of a septal bypass tract. The polarity of the delta wave and maximum QRS forces in precordial lead V1 were discordant in a significant number of patients, pointing to probable shortcomings of a classification based upon the latter.
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Tonkin et al. (1975) conducted an observational in Wolff-Parkinson-White syndrome (n=34). Epicardial mapping and VCG/ECG analysis was evaluated on Relationship between site of epicardial pre-excitation and spatial position of initial forces. Epicardial mapping in patients with Wolff-Parkinson-White syndrome showed the site of pre-excitation correlated with the 10 msec VCG vector in 15 patients and 20 msec ECG vector in 29 patients.