Accuracy of the Electrocardiogram in Localizing the Accessory Pathway in Patients with Wolff-Parkinson-White Pattern

Abstract

BackgroundThere are currently several electrocardiographic algorithms to locate the accessory pathway (AP) in patients with Wolff-Parkinson-White (WPW) syndrome.ObjectiveTo compare the ability of electrocardiographic algorithms in identifying the location of the AP in patients with WPW pattern referred for ablation.MethodsObservational, cross-sectional, retrospective study with 111 patients with WPW syndrome referred for AP ablation. The electrocardiogram (ECG) obtained prior to the ablation was analyzed by an experienced observer who consecutively applied seven algorithms to identify non-invasively the AP. We then compared the location estimated with this assessment with that obtained in the electrophysiological study and calculated the agreement rates.ResultsAmong the APs, 59 (53.15%) were distributed around the mitral annulus and the remaining 52 (46.85%) were located around the tricuspid annulus. The overall absolute accuracy of the algorithms evaluated varied between 27% and 47%, increasing to between 40% and 76% when we included adjacent locations. The absolute agreement rate by AP location was 2.00-52.20% for septal APs (n = 51), increasing to 5.90-90.20% when considering adjacent locations; 7.70-69.20% for right APs (n = 13), increasing to 42.90-100% when considering adjacent locations; and 21.70-54.50% for left APs (n = 47), increasing to 50-87% when considering adjacent locations.ConclusionThe agreement rates observed for the analyzed scores indicated a low discriminative ability of the ECG in locating the AP in patients with WPW.

Primeiros Socorros: Principais Emergências Cardiovasculares

“…A síndrome de Wolff-Parkinson -White (WPW) é uma forma de pré-excitação ventricular na qual parte do miocárdio ventricular é despolarizada precocemente pela existência de uma ou mais Vias Acessórias (VAs) que conduz o estímulo diretamente do átrio para o ventrículo, sem passar pelo nó atrioventricular (AV). As VAs resultam de um desenvolvimento embriológico anormal do miocárdio, durante a diferenciação do tecido fibroso responsável pela separação entre os átrios e os ventrículos (TEIXEIRA et al, 2016).…”

Palpitations in a Young, Healthy Female

“…This bundle arises from the abnormal differentiation of myocardial tissue during embryonic development. 16 This congenital AP tract forms abnormal conductive cardiac tissue between the atria and ventricles, thus providing an alternative tract for conduction, leading to early ventricular depolarization. 1,16 In contrast to the AV node, the AP has rapid anterograde and retrograde conduction without rate limitation.…”

“…16 This congenital AP tract forms abnormal conductive cardiac tissue between the atria and ventricles, thus providing an alternative tract for conduction, leading to early ventricular depolarization. 1,16 In contrast to the AV node, the AP has rapid anterograde and retrograde conduction without rate limitation. 1 This rapid, bidirectional conduction of the electrical stimulus between the atria and ventricles causes ventricular depolarization immediately after atrial depolarization.…”

Localization of Accessory Pathway Using Tissue Doppler Echocardiography Prior Radiofrequency Ablation in Patients with Wolff-Parkinson-White Syndrome

“…In our study, surface ECG algorithm was not used, and there was no control group. 18 Hence, comparison between surface ECG and TDI was not done. Intra-observer variability was not given; no power analysis was done for the study.…”