The Role Of Diagnosing The Location Of Accessory Pathways Using 15-Lead Ecg In Patients With Wolff-Parkinson-White Syndrome

Abstract

Objective: To evaluate the role of the 15-lead ECG with V3R, V4R, and V5R on the surface electrocardiogram in determining the location of accessory pathways in patients with Wolff-Parkinson-White (WPW) syndrome. Methods: A cross-sectional, diagnostic test evaluation study. 43 patients diagnosed with WPW syndrome, whose accessory pathway locations were predicted using a 15-lead surface ECG with V3R, V4R, and V5R, underwent electrophysiological studies and successful radiofrequency ablation at 3 major cardiology centers in Hanoi, Vietnam, from September 2022 to September 2023. Results: The QRS morphology on the right precordial leads (V3R, V4R, V5R) in patients with WPW syndrome had 3 main forms: RS or R form, QS or Qr form, and rS form. The QRS amplitude in V3R, V4R, and V5R being positive for the diagnosis of left-sided accessory pathway had a sensitivity of 80%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 78.3%. The QRS amplitude in V3R, V4R, and V5R being negative for the diagnosis of right-sided accessory pathway had a sensitivity of 100%, specificity of 80%, positive predictive value of 78.3%, and negative predictive value of 100%. The sensitivity, specificity, positive predictive value, and negative predictive value when applying the QRS morphology criterion at V4R as QS or Qr in determining the septal location were 93.3%, 96.4%, 93.3%, and 96.4%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value for right-sided septal pathways were 100%, 93.9%, 83.3%, and 100%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value for left-sided septal pathways were 60%, 100%, 100%, and 95%, respectively. Fluoroscopy time, procedure time, ablation time, and the number of ablation attempts were significantly reduced. Conclusion: Differentiating the location of accessory pathways on the tricuspid and mitral valve annuli has high accuracy, differentiating the location of accessory pathways in the septal region versus the free wall has high accuracy, helping to shorten procedure time and fluoroscopy time when using the criteria for predicting AP location by surface ECG with V3R, V4R, and V5R.