Localization of accessory pathways from the 12-lead electrocardiogram using a new algorithm.
A new algorithm (St. George's algorithm), based on the polarity and morphology of QRS complexes rather than delta waves, was developed for localizing accessory pathways to 1 of 9 sites on the atrioventricular annuli. This was compared with algorithms previously proposed by Skeberis et al (localizing to 1 of 7 sites) and Milstein et al (localizing to 1 of 4 sites). The preexcited 12-lead electrocardiograms recorded during sinus rhythm in 106 consecutive patients (including 60 retrospectively analyzed patients and 46 prospectively analyzed patients) who underwent successful radiofrequency catheter ablation of a single accessory pathway were analyzed by 3 blinded observers using all 3 algorithms. The results were compared with the actual localization of accessory pathways as derived from endocardial mapping during catheter ablation. In all 106 patients, the accuracy of the 3 algorithms for 4 sites on the atrioventricular annuli (as considered by Milstein's method) was 72%, 79%, and 92% for Milstein's, Skeberis', and St. George's algorithms, respectively. For 7 sites (as considered by Skeberis' method), the accuracy was 65% (Skeberis' algorithm) and 88% (St. George's algorithm), and for 9 sites (as considered by our method) the accuracy was 86% (St. George's algorithm). In 46 prospectively analyzed patients, the accuracy of the 3 algorithms for 4 sites was 70% (Milstein's), 67% (Skeberis'), and 87% (St. George's); for 7 sites the accuracy was 61% (Skeberis') and 85% (St. George's), and for 9 sites the accuracy was 85% (St. George's). The reproducibility of St. George's and Skeberis' methods was better than that of Milstein's method.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Cardiological Sciences, St. George's Hospital Medical School, London, United Kingdom.
B
B
Xie
S C
SC
Heald
Y
Y
Bashir
D
D
Katritsis
F D
FD
Murgatroyd
A J
AJ
Camm
E
E
Rowland
D E
DE
Ward
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery; D001283:Atrioventricular Node / Q000503:physiopathology* / Q000601:surgery; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods; D002648:Child; D004562:Electrocardiography / Q000379:methods*; D004594:Electrophysiology; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum / Q000294:innervation / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000503:physiopathology / Q000601:surgery; D014927:Wolff-Parkinson-White Syndrome / Q000503:physiopathology* / Q000601:surgery