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 syn-V4 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.
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Dr. Kobayashi has received research grants from Abbott Medical Japan, Boston Scientific Japan and Medtronic Japan. Dr. Kondo has received research grants from Abbott Medical Japan, Biotronik Japan and Boston Scientific Japan. All other authors do not have a conflict of interest.
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This study protocol was approved by the local ethics committee.
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Informed consent was obtained from all individual participants including in this study.
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Nakano, M., Kondo, Y., Kajiyama, T. et al. Estimation of the accessory pathway location of the manifest Wolf-Parkinson-White syndrome using synthesized right-sided chest leads. J Interv Card Electrophysiol 59, 43–48 (2020). https://doi.org/10.1007/s10840-019-00648-2
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DOI: https://doi.org/10.1007/s10840-019-00648-2