Estimation of the accessory pathway location of the manifest Wolf-Parkinson-White syndrome using synthesized right-sided
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Estimation of the accessory pathway location of the manifest Wolf-Parkinson-White syndrome using synthesized right-sided chest leads Masahiro Nakano 1 & Yusuke Kondo 1 & Takatsugu Kajiyama 2 & Kazuo Miyazawa 2 & Miyo Nakano 2 & Tomohiko Hayashi 2 & Ryo Ito 2 & Haruhiro Takahira 2 & Mari Kitagawa 2 & Yoshio Kobayashi 2 Received: 5 June 2019 / Accepted: 14 October 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Purpose The classification using QRS morphology of V1 lead is a useful simple predictor of accessory pathway location (type A, R or Rs pattern; type B, rS pattern; type C, QS or Qr pattern), but often leads to misdiagnosis of accessory pathway location, especially in types B and C. The synthesized 18-lead electrocardiography (ECG) derived from standard 12-lead ECG can provide virtual waveforms of right-sided chest leads. This study aimed to evaluate the usefulness of the right-sided chest lead ECG for prediction of accessory pathway location. Methods This retrospective study included 44 patients in whom successful ablation of manifest Wolff-Parkinson-White (WPW) syndrome was performed. Synthesized ECG waveforms were automatically generated, and ECG data obtained before the procedure. Results There were 26, 4, and 14 patients with left, right, and septal accessory pathways, respectively. All left accessory pathway cases have type A in V1 and syn-V4R leads. Of the 4 right accessory pathway cases, 2 have type B in V1 and syn-V4R leads. Other 2 of 4 cases have type C. In V1 lead, 5 of 14 septal accessory pathway cases have type C, 7 of 14 cases have type B, and 2 of 14cases have type A. In syn-V4R lead, all 14 septal accessory pathway cases have type C. The QRS morphology of V1 and synV4 leads could predict the site of accessory pathway with overall accuracy of 79% and 95%, respectively. Conclusions QRS morphology of syn-V4R lead may be useful for predicting accessory pathway location of manifest WPW syndrome. Keywords Synthesized electrocardiography . WPW syndrome . Accessory pathway location . Catheter ablation
1 Introduction For successful and safe ablation of patients with manifest Wolff-White-Parkinson syndrome (WPW) syndrome, estimation of accessory pathway location prior to the ablation procedure can be useful. Several detailed algorithms for predicting the accessory pathway location using the delta wave of standard 12-lead electrocardiography (ECG) have been reported in patients with manifest WPW syndrome [1–3]. On the contrary, the
* Masahiro Nakano [email protected] 1
Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
2
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
classification using QRS morphology of V1 lead is a useful simple predictor of accessory pathway location. In this method, the R or Rs pattern (type A) in V1 is a predictor of left accessory pathway, rS pattern (type B) of right accessory pathway, and QS
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