Development and evaluation of surface electrocardiogram in the septal accessory pathway localization in typical Wolff-Parkinson-White syndrome

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.