Body Surface Mapping and Nontraditional ECG Leads in Patients with Wolff‐Parkinson‐White Syndrome

A method of ECG mapping from 90 points on the chest surface is described in 41 male and 17 female patients, aged 6 to 59 years. All also underwent invasive electrophysiological investigation and intraoperative epicardial mapping. Fifty‐two patients had one, three patients two, and one patient had three anomalous accessory pathways. Two patients had nodoventricular tracts (Mahaim fibers). We distinguished seven zones along the atrioventricular groove (AVG) to compare the data derived from epicardial, endocardial, and body surface mapping. A microcomputer was used for the anaJysis of all ECGs to construct and analyze the isopotential maps. The criterion for localization of the anomalous accessory pathways was determined after analysis of the data from all 58 patients. The localization criterion was the appearance of a minimal deflection (−0.09 ± 0.03 mV) on the surface isopotential maps within the first 0.28 msec of the QHS complex. This criterion for localization of anomalous accessory pathways from the chest surface was proposed on the basis of comparison of data from selective coronary angiography, the ventriculogram, and the chest X ray i.e., radiographic‐topographic‐anatomical data. In 20 patients, 10–20 nontraditional ECG leads were recorded from the chest to reflect the atrioventricular groove. The number of nontraditional ECG leads depended on patient age, weight, and height. Localization of the accessory pathway in one of the seven zones was established by the earliest delta wave and its maximum deviation. It was possible to localize the anomalous accessory pathway and to suspect multiple pathways in 95% of cases using nontraditional ECG leads and the listed criteria. Comparison of results of body surface mapping with X ray‐topographic‐anatomical data made determination of the anomalous accessory pathway possible with a high degree of success. We propose a new system of 10–20 nontraditional ECG leads recording data from the AVG projection onto the chest surface for topical localization of the Kent bundle in one of the seven zones into which the AVG was divided.