EASY-WPW: a novel ECG-algorithm for easy and reliable localization of manifest accessory pathways in children and adults

Abstract

Aims Accessory pathway (AP) ablation is a standard procedure for the treatment of Wolff-Parkinson-White syndrome (WPW). Twelve-lead electrocardiogram (ECG)-based delta wave analysis is essential for predicting ablation sites. Previous algorithms have shown to be complex, time-consuming, and unprecise. We aimed to retrospectively develop and prospectively validate a new, simple ECG-based algorithm considering the patients’ heart axis allowing for exact localization of APs in patients undergoing ablation for WPW. Methods and results Our multicentre study included 211 patients undergoing ablation of a single manifest AP due to WPW between 2013 and 2021. The algorithm was developed retrospectively and validated prospectively by comparing its efficacy to two established ones (Pambrun and Arruda). All patients (32 ± 19 years old, 47% female) underwent successful pathway ablation. Prediction of AP-localization was correct in 197 patients (93%) (sensitivity 92%, specificity 99%, PPV 96%, and NPV 99%). Our algorithm was particularly useful in correctly localizing antero-septal/-lateral (sensitivity and specificity 100%) and posteroseptal (sensitivity 98%, specificity 92%) AP in proximity to the tricuspid valve. The accuracy of EASY-WPW was superior compared to the Pambrun (93% vs. 84%, P = 0.003*) and the Arruda algorithm (94% vs. 75%, P < 0.001*). A subgroup analysis of children (n = 58, 12 ± 4 years old, 55% female) revealed superiority to the Arruda algorithm (P < 0.001*). The reproducibility of our algorithm was excellent (ϰ>0.8; P < 0.001*). Conclusion The novel EASY-WPW algorithm provides reliable and accurate pre-interventional ablation site determination in WPW patients. Only two steps are necessary to locate left-sided AP, and three steps to determine right-sided AP.

The R″ wave in V1 and the negative terminal QRS vector in aVF combine to a novel 12-lead ECG algorithm to identify slow conducting anatomical isthmus 3 in patients with tetralogy of Fallot

“…An easy-to-use and reliable diagnostic ECG algorithm, as present for other aetiologies, is desirable. 33 One risk marker for VT and SCD has been an RBBB-like QRS prolongation ≥180 ms on the 12-lead ECG. 16 In contemporary rTOF patients, QRS duration ≥180 ms is only observed in 6–8% and the predictive value for the occurrence of VT is moderate.…”

Diagnosis and treatment of fetal and pediatric age patients (0–12 years) with Wolff–Parkinson–White syndrome and atrioventricular accessory pathways

“…Reliable algorithms exist. 16,17 The echocardiogram, once associated structural or CHD have been ruled out, must verify, during follow-up, the occurrence of dysfunction from contractile dyssynchrony.…”

“…In the ECG, the characteristics of the delta and R waves during sinus rhythm and that of the P wave during tachycardia allow the localization of the AP with good approximation. Reliable algorithms exist 16,17 …”

Clinical implications of a unique delta wave pattern in patients with left-sided Wolff–Parkinson–White

“…While more recent algorithms have focused on precordial leads for localization, 10 negative delta waves in lead II have traditionally been associated with subepicardial AP requiring ablation within the coronary sinus (CS). 7 In evaluation of our contemporary institutional experience with left-sided manifest AP, we identified a unique pre-excitation morphology with prominent negative delta waves both in the inferior leads, as well as the left lateral precordial leads.…”

“…In summary, evaluation of our contemporary institutional experience with manifest left-sided AP has unearthed a subset of abnormal AP within the CS body identifiable by pre-procedural ECG, comparable to pathways located within the proximal CS or CS diverticulum. 7 , 10 , 13–15 These pathways are notoriously difficult to ablate and often have high recurrence rates. 15 Given that these pathways run over a layer of myocardium that coats the CS, it can be difficult to deliver adequate energy to the desired location.…”