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12 Lead electrocardiogram algorithm for the localization of accessory pathways using simple parameters in patients with typical Wolff-Parkinson-White syndrome

Si Dung Chu, Khanh Quoc Pham and Dong Van Tran

Objective: This study was designed to characteristics of 12-lead electrocardiogram (ECG) to compare the position of accessory pathway (APs) in the typical Wolff-Parkinson-White (WPW) syndrome, can be build a new ECG algorithm for the localization of AP. Subjects and method: In 189 patients with typical WPW syndrome have a single anterogradely conducting APs on 12-lead ECG parameters were compared with the localization of APs identified by successful radiofrequency catheter ablation (RCFA). Results: We have developed a new ECG algorithm in localizing APs by the 12-lead ECG with simple parameters such as difference between the left or right side by positive/negative delta wave in V1, the anterior or posterior sites by positive/negative delta wave in at least 2/3 inferior lead, the septal or free wall sites by QRS complex transition in V1V2 lead or after V1V2/before V1; Different in LAL or LL region by R/S>1 or R/S<1, R in V1, the RL or RPL region by positive/negative QRS complex in at least 2/3 inferior lead, midseptal had QRS complex morphology’s specify (Qrs, qRs, qrS) in at least 1/3 inferior lead. The new ECG algorithm had high predictive value from 74.5% to 100%; The ECG parameters in algorithm were closely related to AP position. Conclusion: The 12-lead ECG parameters in typical WPW syndrome closely related to APs localization and can be used to a new ECG algorithm for the localization of AP by simple parameters.