A P- to delta-wave interval cut-off of 90.5 ms predicted an antegrade effective refractory period ≥ 240 ms with 80% sensitivity and 83% specificity.
Observational (n=103)
Does the shortest P- to delta-wave interval (PDI) on surface ECG correlate with accessory pathway properties (APERP) in patients with pre-excitation?
A P- to delta-wave interval (PDI) cut-off of 90.5 ms on surface ECG can predict an antegrade effective refractory period (APERP) ≥ 240 ms with 80% sensitivity and 83% specificity, offering a potential non-invasive risk stratification tool for WPW syndrome.
p-value: p=< 0.001
BACKGROUND: The first clinical manifestation of the Wolff-Parkinson-White syndrome in previously asymptomatic individuals may be sudden cardiac death. The options for non-invasive risk stratification are limited in the current era beyond ambulatory rhythm monitoring and an exercise stress test. In our study, we sought to investigate whether there was a relationship between the shortest measured P- to delta-wave time interval (PDI) on the conduction properties of surface electrocardiogram and accessory pathways expressed as antegrade effective refractory period (APERP). METHODS: Demographic data, symptom status, electrocardiograms (ECG) and intra-cardiac recordings of invasive electrophysiology testing of 103 patients who underwent accessory pathway ablation procedures were collected. Exclusion criteria were: (1) intermittently occurring pre-excitation, which was detected in previous ECGs, (2) delta-wave resolution on treadmill test, (3) presence of multiple accessory pathways, and (4) accessory pathway locations other than the septum. The PDI was measured as the time interval from the beginning of the P wave to the earliest upstroke or downstroke of the delta wave on V1 and V2 derivations of the surface ECG, and the shortest measurement was recorded. RESULTS: < 0.001). The best cut-off value for PDI to predict APERP ≥ 240 was 90.5 ms with a sensitivity of 80% and a specificity of 83%. CONCLUSIONS: Our results demonstrate that there was a strong correlation between the P- to delta-wave interval and universally accepted risk factors, such as low age, low APERP and atrial fibrillation inducibility. Further studies with larger patient groups and follow-up data are needed to appraise its predictive value.
Yontar et al. (Wed,) conducted a observational in Pre-excitation (Wolff-Parkinson-White syndrome) (n=103). P- to delta-wave time interval (PDI) was evaluated on Prediction of antegrade effective refractory period (APERP) ≥ 240 ms (p=< 0.001). A P- to delta-wave interval cut-off of 90.5 ms predicted an antegrade effective refractory period ≥ 240 ms with 80% sensitivity and 83% specificity.
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