Abstract
Introduction: The primary line of management for symptomatic accessory pathway is catheter ablation. For effective mapping and ablation, accurate localization of the Accessary Pathway (AP) is critical but usually challenging, especially for the posteroseptal region.
Aim: We aimed at studying the accuracy of different surface ECG algorithms in determining the site of posteroseptal AP in comparison with Electrophysiological study (EPS) and the ablation approach.
Methods: We included 65 patients with possible manifest posteroseptal AP in a prospective observational study. Provisional determination of the site of AP was done using the Arruda et al. algorithm, the Fitzpatrick et al. algorithm, and the Pambrun et al. algorithm in both basal and maximal preexcitation conditions (using atrial pacing during EPS) and compared with the EPS localization. The ablation approach, either left or right was also recorded.
Results: The current study included 65 patients with manifest posterospetal AP. Among them 48.5% were males with a mean age of 33±11 years. We have found that Pambrun's algorithm and Fitzpatrick’s algorithm (during resting ECG) had perfect agreement and accuracy [k 0.879 & 0.844, accuracy 95.4% (CI 87.1–99.0%) & 93.9% (CI 84.9–98.3%) respectively] and ablation approach [k 0.953 &0.864, accuracy 98.5% (CI 91.7– 99.9%) & 96.9% (CI 89.3–99.6%) respectively], followed by Fitzpatrick’s algorithm (during maximal preexcitation). However, Arruda's algorithm had moderate agreement both during resting and maximal preexcitation conditions.
Conclusion: Pambrun’s and Fitzpatrick’s algorithms (resting ECG) showed the highest accuracy and strongest agreement with EPS for localization of posteroseptal AP and ablation approach, indicating their superior reliability for noninvasive prediction of the posteroseptal AP site.
Keywords
Wolff-Parkinson-White syndrome, Catheter ablation, Electrocardiography, Electrophysiological techniques, Accessory pathway