Hsing-Yuan Li1,2,3, Shih-Lin Chang4,5, Chi-Hsi Chuang6, Ming-Chih Lin2,6, Yenn-Jiang Lin4,5, Li-Wei Lo4,5, Yu-Feng Hu4,5, Fa-Po Chung4,5, Yao-Ting Chang4,5, Chieh-Mao Chung4,7, Shih-Ann Chen4,5, Pi-Chang Lee1,2. 1. Division of Cardiology, Department of Pediatrics, Taipei Veterans General Hospital. 2. Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei. 3. Department of Biological Science and Technology, National Chiao Tung University, Hsinchu. 4. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital. 5. Institute of Clinical Medicine and Cardiovascular Research Institute, National Yang-Ming University, Taipei. 6. Division of Cardiology, Department of Pediatrics, Taichung Veterans General Hospital. 7. Department of Pediatric Cardiology, Chinese Medical University Children's Hospital, Taichung, Taiwan.
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 with WPW 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 with WPW 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 with WPW syndrome.
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 with WPW 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 with WPW 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 with WPW syndrome.
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