A novel and simple algorithm using surface electrocardiogram that localizes accessory conduction pathway in Wolff-Parkinson-White syndrome in pediatric patients

Hsing Yuan Li, Shih Lin Chang, Chi Hsi Chuang, Ming Chih Lin, Yenn Jiang Lin, Li Wei Lo, Yu Feng Hu, Fa Po Chung, Yao Ting Chang, Chieh Mao Chung, Shih Ann Chen, Pi Chang Lee*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Background: The location of the accessory pathway (AP) can be precisely identified on surface electrocardiography (ECG) in adults with Wolff-Parkinson-White (WPW) syndrome. However, current algorithms to locate the AP in pediatric patients withWPW syndrome are limited. Objective: To propose an optimal algorithm that localizes the AP in pediatric patients with WPW syndrome. Methods: From 1992 to 2016, 180 consecutive patients aged below 18 years with symptomatic WPW syndrome were included. After the exclusion of patients with non-descriptive electrocardiography (ECG),multiple APs, congenital heart diseases, non-inducible tachycardia, and those who received a second ablation, 104 patients were analyzed retrospectively. Surface ECG was obtained before ablation and evaluated by using previously documented algorithms, from which a new pediatric algorithm was developed. Results: Previous algorithms were not highly accurate when used in pediatric patients withWPW syndrome. In the new algorithm, the R/S ratio of V1 and the polarity of the delta wave in lead I could distinguish right from the left side AP with 100% accuracy. The polarity of the delta wave of lead V1 could distinguish free wall AP from septal AP with an accuracy of 100% in left-side AP, compared to 88.6% in leads III and V1 for right-side AP. The overall accuracy was 92.3%. Conclusions: This simple, novel algorithm could differentiate left from right AP and septal from free wall AP in pediatric patients withWPW syndrome.

Original languageEnglish
Pages (from-to)493-500
Number of pages8
JournalActa Cardiologica Sinica
Volume35
Issue number5
DOIs
StatePublished - 2019

Keywords

  • Accessory pathway
  • Algorithm
  • Children
  • Localization
  • WPW syndrome

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