Does a 12-lead ECG-based algorithm accurately localize accessory pathways in patients with Wolff-Parkinson-White syndrome compared to electrophysiological or intraoperative mapping?
A simple 12-lead ECG algorithm can accurately localize accessory pathways in WPW syndrome, providing a valuable first approximation before nonpharmacological therapies.
Accessory pathway location in the Wolff-Parkinson-White syndrome influences the success and morbidity of nonpharmacological therapies, so that an estimate of accessory pathway location is relevant to the practicing physician. We derived an algorithm for accessory pathway localization based on the surface electrocardiogram; we tested it in a population of 141 patients with the Wolff-Parkinson-White syndrome in whom accessory pathway localization was made by electrophysiological and/or intraoperative mapping. The goal of the algorithm was to localize the accessory pathway to one of four anatomic regions, namely, left free wall, posteroseptal, anteroseptal or right free wall by using a simple, easy-to-apply scheme. Each of two observers, blinded to the results of mapping, correctly identified the anatomic location of 91% and 90% of pathways, respectively. We conclude that a simple algorithm utilizing the 12-lead electrocardiogram can provide a valuable first approximation of accessory pathway location in the Wolff-Parkinson-White syndrome.
Milstein et al. (Fri,) studied this question.
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