scholarly journals Assessment of P- to delta-wave interval and its relationship with accessory pathway properties in patients with pre-excitation

2021 ◽  
Vol 32 (6) ◽  
pp. 6-10
Author(s):  
Osman Can Yontar ◽  
Ahmet Yanik ◽  
Gokhan Aksan
Keyword(s):  
Accessory Pathway ◽  
Delta Wave

scholarly journals Split Accessory Pathway Potentials in a Patient with Antidromic AVRT

2021 ◽  
Author(s):  
Weizhuo Liu ◽  
Wentao Gu ◽  
Xinping Luo ◽  
Jian Li ◽  
Nanqing Xiong
Keyword(s):  
Accessory Pathway ◽  
Conduction Delay ◽  
Tricuspid Annulus ◽  
Reentrant Tachycardia ◽  
Delta Wave ◽  
Electrophysiology Study ◽  
Isoproterenol Infusion

A 27-year-old female presenting palpitation without ECG documentation underwent electrophysiology study. EP study revealed atrioventricular accessory pathway with poor and unidirectional pathway conduction, and a fasciculoventricular pathway. During isoproterenol infusion, delta wave promptly became prominent, after which an antidromic AV reentrant tachycardia was induced. When the pathway was mapped, widely split double pathway potentials were observed at 12 o’clock site of tricuspid annulus during mild preexcitation, demonstrating an example of intra-pathway conduction delay, which can be reversed by isoproterenol. Ablation at the site caused accelerated pathway rhythm and eliminated the pathway, rendering the tachycardia non-inducible.

scholarly journals ID: 1081 Development and validation of surface electrocardiogram in the septal accessory pathway localization in typical Wolff-Parkinson-White syndrome

2017 ◽  
Vol 4 (S) ◽  
pp. 167
Author(s):  
Si Dung Chu ◽  
Khanh Quoc Pham ◽  
Dong Van Tran
Keyword(s):  
Accessory Pathway ◽  
High Sensitivity ◽  
High Accuracy ◽  
Qrs Complex ◽  
Delta Wave ◽  
Wpw Syndrome ◽  
Development And Validation ◽  
Electrocardiogram Ecg ◽  
Surface Electrocardiogram ◽  
Wolff Parkinson White Syndrome

Objectives: This study was designed characteristics of surface electrocardiogram (ECG) for the localization of septal accessory pathway (AP) in the typical Wolff-Parkinson-White (WPW) syndrome to develop a new algorithm ECG for the septal AP localization, and to test the accuracy of the algorithm prospectively.  Subject and Methods: We studied 106 patients, in 65 patients with typical WPW syndrome have a single anterograde with the localization of Aps identified by successful radiofrequency catheter ablation (RCFA) to develop a new ECG algorithm for the septal AP localization. Then this algorithm was tested propectively in 41 patients were compared with the location of AP’s successful ablation by RCFA (gold standard).  Results: We found that the 12 lead ECG parameters in 65 patients with typical WPW syndrome such as the transition of the QRS complex, delta wave polarity in V1 lead, delta wave polarity in at least 2/3 inferior leads and morphology QRS was “QRS pattern’’ in inferior leads in diagnosis for the localization of septal APs with hight accuracy predicted from 83.3% to 100%, and for development of a new ECG algorithm. Then the following 41 patients were prospectively evaluated by the new derived algorithm for the septal pathways with high sensitivity and specificity from 84.6% to 100%.  Conclusion: 12-lead ECG parameters in typical WPW syndrome closely related to the septal AP localization, in order to develop the new ECG algorithm by parameters as above; and can be used to a new septal ECG algorithm in predicted the location APs with high accuracy predicted

scholarly journals Development and evaluation of surface electrocardiogram in the septal accessory pathway localization in typical Wolff-Parkinson-White syndrome

2018 ◽  
Vol 5 (9) ◽  
pp. 2680-2687
Author(s):  
Si Dung Chu ◽  
Khanh Quoc Pham ◽  
Dong Van Tran
Keyword(s):  
Accessory Pathway ◽  
High Sensitivity ◽  
High Accuracy ◽  
Strongly Correlated ◽  
Qrs Complex ◽  
Delta Wave ◽  
Wpw Syndrome ◽  
Electrocardiogram Ecg ◽  
Surface Electrocardiogram ◽  
Wolff Parkinson White Syndrome

Objectives: This study was designed to characterize the surface electrocardiogram (ECG) of the typical Wolff-Parkinson-White (WPW) syndrome to develop a new algorithm ECG to localize the septal accessory pathways (APs) and to prospectively test the accuracy of the algorithm. Methods: We studied 106 patients, in which 65 patients with typical WPW syndrome who had a single antero-grade with the localization of APs identified by successful radiofrequency catheter ablation (RFCA) to develop a new ECG algorithm for the septal AP localization. Then, this algorithm was tested prospectively in 41 patients to compare to the localization of APs by successful ablation by RFCA (gold standard). Results: In 65 patients with typical WPW syndrome, we found that the 12-lead ECG parameters such as the transition of the QRS complex, delta wave polarity in V1 lead, delta wave polarity in at least 2/3 inferior leads and ``QRS pattern'' in inferior leads can predict the localization of septal APs with the accuracy ranging from 83.3% to 100%. Then, 41 patients were prospectively evaluated by the new derived algorithm to localize the septal APs with high sensitivity and specificity from 84.6% to 100%. Conclusion: 12-lead ECG parameters in typical WPW syndrome are strongly correlated to the septal AP localization, which can be used to develop a new ECG algorithm to localize septal APs with high accuracy.

scholarly journals A new electrocardiographic marker with higher sensitivity and specificity for epicardial location of posteroseptal accessory pathway

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Badiul ◽  
C Iorgulescu ◽  
S Bogdan ◽  
A Radu ◽  
S Paja ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Statistical Significance ◽  
Accessory Pathway ◽  
Lower Sensitivity ◽  
S Wave ◽  
Delta Wave ◽  
Accessory Pathways ◽  
Specificity And Sensitivity

Abstract Funding Acknowledgements Type of funding sources: None. Introduction   Catheter ablation of accessory pathways (AP) located in the posterior pyramidal space are often challenging due to its anatomical complexity. Scarce of data are available about the ECG features that might indicate when an epicardial approach is required in the ablation of the posteroseptal AP. Objective The purpose of this retrospective study was to describe the electrocardiographic features of posteroseptal AP which have been successfully ablated with epicardial approach and identify electrocardiographic predictors for epicardial AP location. Methods The 12 leads ECG of 75 patients with posteroseptal accessory pathways who were successfully ablated were retrospectively analyzed. ECG features for epicardial location described already in published studies have been considered (negative delta wave in DII, positive delta wave in aVR, high amplitude S wave in V6). Additionally the characteristics of the initial 40 ms of the delta wave in lead V1 (measured from the earliest QRS deflection in 12 leads) during full pre-excitation have been investigated. Results Of 75 patients with posteroseptal AP that undergone catheter ablation, 40 (53.3%) had successful epicardial ablation. An initial isoelectric or biphasic delta wave in lead V1 proved the highest sensitivity (82.5 %) respectively positive predictive value (97 %) and  specificity (97 %) for an epicardial location of the AP. Deep S wave in V6 proved lower sensitivity (37.5%) and positive predictive value (68%) but higher specificity (80%) for epicardial location of AP. The specificity and sensitivity for epicardial location of AP of negative delta wave in DII were lower, however it failed to reach statistical significance.  Conclusion This study shows that an initially isoelectric or biphasic delta wave aspect in lead V1 has a higher specificity, sensitivity and positive predictive value than previously described ECG markers for epicardial location of posteroseptal accessory pathways.

scholarly journals Delta wave automatic mapping and catheter ablation without fluoroscopy in patients with overt accessory pathway: a new workflow

2021 ◽  
Author(s):  
Saverio Iacopino ◽  
Jacopo Colella ◽  
Francesca Pesce ◽  
Paolo Artale ◽  
Gennaro Fabiano ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Accessory Pathway ◽  
Delta Wave ◽  
Automatic Mapping

scholarly journals ID: 1043 Study value of 12-lead ECG for the left free wall of accessory pathways diagnosing in patients with typical Wolff-Parkinson-White Syndrome

2017 ◽  
Vol 4 (S) ◽  
pp. 122
Author(s):  
Chu Dung Si ◽  
Pham Quoc Khanh ◽  
Tran Van Dong
Keyword(s):  
Radiofrequency Catheter Ablation ◽  
Accessory Pathway ◽  
High Sensitivity ◽  
High Accuracy ◽  
Free Wall ◽  
Qrs Complex ◽  
Delta Wave ◽  
Wpw Syndrome ◽  
Electrocardiogram Ecg ◽  
Wolff Parkinson White Syndrome

Objectives: This study was designed characteristics of 12-lead Electrocardiogram (ECG) for the left free wall lateral of accessory pathway (AP) localization in the typical WPW syndrome to develop a new algorithm ECG for localizing APs, and to test the accuracy of the algorithm prospectively. Methods: We studied 129 patients, in 84 patients with typical WPW syndrome have a single anterograde with the localization of APs identified by successful radiofrequency catheter ablation (RCFA) to develop a new ECG algorithm for the left free wall of localizing APs. Then this algorithm was tested prospectively in 45 patients were compared with the location of AP’s successful ablation by RCFA.  Results: We found that the 12 lead ECG parameters in typical WPW syndrome such as delta wave polarity in V1, R/S ratio in V1, the transition of the QRS complex, delta wave polarity in inferior leads in diagnosis for the localization of APs by with high accuracy predicted from 74,5% to 100%, and for development of a new ECG algorithm. Then the following 45 patients were prospectively evaluated by the new derived algorithm for the left free wall pathways with high sensitivity and specificity from 75% to 100%. Conclusion: 12-lead ECG parameters in typical WPW syndrome closely related to left free wall of APs localization, in order to develop the new ECG algorithm by parameters as above; and can be used to a new ECG algorithm in predicting the location APs with high accuracy.

scholarly journals Identifying the Location of an Accessory Pathway in Pre-Excitation Syndromes Using an Artificial Intelligence-Based Algorithm

2021 ◽  
Vol 10 (19) ◽  
pp. 4394
Author(s):  
Thomas Senoner ◽  
Bernhard Pfeifer ◽  
Fabian Barbieri ◽  
Agne Adukauskaite ◽  
Wolfgang Dichtl ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Catheter Ablation ◽  
Predictive Accuracy ◽  
Accessory Pathway ◽  
Electrophysiologic Study ◽  
Delta Wave ◽  
Wpw Syndrome ◽  
Invasive Electrophysiologic ◽  
Anatomic Localization ◽  
Excellent Accuracy

(1) Background: The exact anatomic localization of the accessory pathway (AP) in patients with Wolff–Parkinson–White (WPW) syndrome still relies on an invasive electrophysiologic study, which has its own inherent risks. Determining the AP localization using a 12-lead ECG circumvents this risk but is of limited diagnostic accuracy. We developed and validated an artificial intelligence-based algorithm (location of accessory pathway artificial intelligence (locAP AI)) using a neural network to identify the AP location in WPW syndrome patients based on the delta-wave polarity in the 12-lead ECG. (2) Methods: The study included 357 consecutive WPW syndrome patients who underwent successful catheter ablation at our institution. Delta-wave polarity was assessed by four independent electrophysiologists, unaware of the site of successful catheter ablation. LocAP AI was trained and internally validated in 357 patients to identify the correct AP location among 14 possible locations. The AP location was also determined using three established tree-based, ECG-based algorithms (Arruda, Milstein, and Fitzpatrick), which provide limited resolutions of 10, 5, and 8 AP locations, respectively. (3) Results: LocAP AI identified the correct AP location with an accuracy of 85.7% (95% CI 79.6–90.5, p < 0.0001). The algorithms by Arruda, Milstein, and Fitzpatrick yielded a predictive accuracy of 53.2%, 65.6%, and 44.7%, respectively. At comparable resolutions, the locAP AI achieved a predictive accuracy of 95.0%, 94.9%, and 95.6%, respectively (p < 0.001 for differences). (4) Conclusions: Our AI-based algorithm provided excellent accuracy in predicting the correct AP location. Remarkably, this accuracy is achieved at an even higher resolution of possible anatomical locations compared to established tree-based algorithms.

scholarly journals Development and evaluation of 12-lead electrocardiogram in the left free wall of accessory pathway localization in patients with typical Wolff-Parkinson-White syndrome

2018 ◽  
Vol 5 (11) ◽  
pp. 2832-2840
Author(s):  
Si Dung Chu ◽  
Khanh Quoc Pham ◽  
Dong Van Tran
Keyword(s):  
Radiofrequency Catheter Ablation ◽  
Accessory Pathway ◽  
High Accuracy ◽  
Free Wall ◽  
Qrs Complex ◽  
White Syndrome ◽  
Delta Wave ◽  
Wpw Syndrome ◽  
Electrocardiogram Ecg ◽  
Wolff Parkinson White Syndrome

Objectives: This study was designed to characterize 12-lead electrocardiogram (ECG) for localization of the left free wall lateral accessory pathway (AP) in patients with typical Wolff-Parkinson-White (WPW) syndrome, to develop a new algorithm ECG for localizing APs, and to test the accuracy of the algorithm prospectively. Method: We studied 129 patients; 84 patients had typical WPW syndrome with single anterograde AP identified by successful radiofrequency catheter ablation (RFCA), and were enrolled to build a new ECG algorithm for localizing left free wall APs. Then, the algorithm was tested prospectively in 45 patients and compared with the location of APs successfully ablated by RFCA. Results: We found that the 12-lead ECG parameters in typical WPW syndrome, such as delta wave polarity in V1, R/S ratio in V1, transition of the QRS complex, and delta wave polarity in inferior, lead to diagnosis and localization of APs, with highest accuracy predicted from 74.5%-100%, and for development of a new ECG algorithm. From the 45 patients who were prospectively evaluated by the newly derived algorithm for the left free wall pathways, the sensitivity and specificity was high (from 75-100%). Conclusion: The 12-lead ECG parameters in typical WPW syndrome are closely related to left free wall AP localization and can be used to develop a new ECG algorithm by the parameters above. Moreover, the new ECG algorithm can predict the location of APs with high accuracy.  

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