New algorithm for the localization of accessory atrioventricular connections using a baseline electrocardiogram

Objectives. In this study, we propose a new algorithm for accessory atrioventricalar pathway localization using a 12-lead electrocardiogram (ECG). Background. Radiofrequency catheter ablation produces a very discrete lesion, and ECG localization based en surgical dissection is obsolete. Methods. Ste...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 1994-01, Vol.23 (1), p.107-116
Main Authors: Fitzpatrick, Adam P., Gonzales, Rolando P., Lesh, Michael D., odin, Gunnard W., Lee, Randall J., Scheinman, Melvin M.
Format: Article
Language:English
Subjects:
Algorithms
Catheter Ablation
Discriminant Analysis
Electrocardiography
Female
Heart Conduction System - abnormalities
Heart Conduction System - surgery
Humans
Male
Predictive Value of Tests
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Summary:Objectives. In this study, we propose a new algorithm for accessory atrioventricalar pathway localization using a 12-lead electrocardiogram (ECG). Background. Radiofrequency catheter ablation produces a very discrete lesion, and ECG localization based en surgical dissection is obsolete. Methods. Stepwise discrimination analysis was used to assess the relation of 18 pro-excited ECG (QRS duration >100 ms) variables to the site of successful ablation in 93 patients. The most discriminating variables were combined to form rules for each location. The ECGs were retested by these rules to determine predictive accuracy. Results. If the precordlal QRS transition was at or before lead V1, the pathway had been ablated on the left side. If it was after lead V2, the pathway had been ablated on the right side. If the QRS transition was between leads V1and V2or at lead V2, then if the R wave amplitude in lead I was greater the S wave by ≥1.0 mV, it was right-sided; otherwise, It was left-sided (p < 0.0001, sensitivity 100%, specificity 97%). Right-sided pathways. If the QRS transition was between leads V2and V3, the pathway was right septal; if after lead V4, it was right lateral. If it was between leads V3and V4, then if the delta wave amplitude in lead II was ≥1.0 mV, it was right septal; otherwise, it was right lateral (p < 0.0001, sensitivity 97% specificity 95%). In right lateral locations, if the delta wave frontal axis was ≥0 °, or if it was
ISSN:0735-1097
1558-3597
DOI:10.1016/0735-1097(94)90508-8