A simple algorithm for localizing accessory pathways in patients with Wolff-Parkinson-White syndrome using only the R/S ratio
Background: Several algorithms for localizing accessory pathways (APs) are based on the delta wave morphology, R/S ratio, and QRS polarity. However, they are somewhat complicated, and an accurate determination of the delta wave morphology is occasionally difficult. The aims of this study were to dev...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2014-12-01
|
| Series: | Journal of Arrhythmia |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1880427613001658 |
| _version_ | 1811283890999918592 |
|---|---|
| author | Noriko Taguchi, MD Naoki Yoshida, MD, PhD Yasuya Inden, MD, PhD Toshihiko Yamamoto, MD Shinjiro Miyata, MD Masaya Fujita, MD Kenichiro Yokoi, MD Seifuku Kyo, MD Masayuki Shimano, MD, PhD Makoto Hirai, MD, PhD Toyoaki Murohara, MD, PhD |
| author_facet | Noriko Taguchi, MD Naoki Yoshida, MD, PhD Yasuya Inden, MD, PhD Toshihiko Yamamoto, MD Shinjiro Miyata, MD Masaya Fujita, MD Kenichiro Yokoi, MD Seifuku Kyo, MD Masayuki Shimano, MD, PhD Makoto Hirai, MD, PhD Toyoaki Murohara, MD, PhD |
| author_sort | Noriko Taguchi, MD |
| collection | DOAJ |
| description | Background: Several algorithms for localizing accessory pathways (APs) are based on the delta wave morphology, R/S ratio, and QRS polarity. However, they are somewhat complicated, and an accurate determination of the delta wave morphology is occasionally difficult. The aims of this study were to develop a simple algorithm for localizing APs using only the R/S ratio, and to test the accuracy of the algorithm prospectively.
Methods: We studied 142 patients with a single anterogradely conducting AP on a 12-lead ECG. R/S ratios were analyzed in leads V1, V2, and aVF (R/S-V1, R/S-V2, and R/S-aVF). AP locations were divided into five regions based on fluoroscopic anatomy.
Results: A new algorithm was developed by correlating R/S-V1, R/S-V2, and R/S-aVF with successful ablation sites in 88 initial consecutive patients. All 55 patients with left free wall APs showed R/S-V1 ≥0.5, and 47 (98%) of 48 patients with left anterior or lateral APs showed R/S-aVF ≥1. In contrast, all seven patients with left posterolateral or posterior APs showed R/S-aVF <1. All nine patients with right-and-left midseptal or posteroseptal APs showed R/S-V1 <0.5 and R/S-V2 ≥0.5. Of 12 patients with right anterior, lateral or anteroseptal APs, 10 (83%) showed R/S-V1 <0.5, R/S-V2 <0.5 and R/S-aVF ≥1. Finally, nine (75%) of 12 patients with right posterolateral or posterior APs showed R/S-V1 <0.5, R/S-V2 <0.5, and R/S-aVF <1. Then this algorithm was tested prospectively in 54 patients. Overall, the sensitivity was 94%, and the specificity was 98%.
Conclusions: This ECG algorithm provides a simple and accurate way to identify the AP localization. |
| first_indexed | 2024-04-13T02:20:26Z |
| format | Article |
| id | doaj.art-a476d2a01ca04ccbb25337bae0f6b4b2 |
| institution | Directory Open Access Journal |
| issn | 1880-4276 |
| language | English |
| last_indexed | 2024-04-13T02:20:26Z |
| publishDate | 2014-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Arrhythmia |
| spelling | doaj.art-a476d2a01ca04ccbb25337bae0f6b4b22022-12-22T03:07:01ZengWileyJournal of Arrhythmia1880-42762014-12-0130643944310.1016/j.joa.2013.10.006A simple algorithm for localizing accessory pathways in patients with Wolff-Parkinson-White syndrome using only the R/S ratioNoriko Taguchi, MDNaoki Yoshida, MD, PhDYasuya Inden, MD, PhDToshihiko Yamamoto, MDShinjiro Miyata, MDMasaya Fujita, MDKenichiro Yokoi, MDSeifuku Kyo, MDMasayuki Shimano, MD, PhDMakoto Hirai, MD, PhDToyoaki Murohara, MD, PhDBackground: Several algorithms for localizing accessory pathways (APs) are based on the delta wave morphology, R/S ratio, and QRS polarity. However, they are somewhat complicated, and an accurate determination of the delta wave morphology is occasionally difficult. The aims of this study were to develop a simple algorithm for localizing APs using only the R/S ratio, and to test the accuracy of the algorithm prospectively. Methods: We studied 142 patients with a single anterogradely conducting AP on a 12-lead ECG. R/S ratios were analyzed in leads V1, V2, and aVF (R/S-V1, R/S-V2, and R/S-aVF). AP locations were divided into five regions based on fluoroscopic anatomy. Results: A new algorithm was developed by correlating R/S-V1, R/S-V2, and R/S-aVF with successful ablation sites in 88 initial consecutive patients. All 55 patients with left free wall APs showed R/S-V1 ≥0.5, and 47 (98%) of 48 patients with left anterior or lateral APs showed R/S-aVF ≥1. In contrast, all seven patients with left posterolateral or posterior APs showed R/S-aVF <1. All nine patients with right-and-left midseptal or posteroseptal APs showed R/S-V1 <0.5 and R/S-V2 ≥0.5. Of 12 patients with right anterior, lateral or anteroseptal APs, 10 (83%) showed R/S-V1 <0.5, R/S-V2 <0.5 and R/S-aVF ≥1. Finally, nine (75%) of 12 patients with right posterolateral or posterior APs showed R/S-V1 <0.5, R/S-V2 <0.5, and R/S-aVF <1. Then this algorithm was tested prospectively in 54 patients. Overall, the sensitivity was 94%, and the specificity was 98%. Conclusions: This ECG algorithm provides a simple and accurate way to identify the AP localization.http://www.sciencedirect.com/science/article/pii/S1880427613001658Wolff-Parkinson-White syndromeAccessory pathwaysR/S ratioElectrocardiogramAlgorithm |
| spellingShingle | Noriko Taguchi, MD Naoki Yoshida, MD, PhD Yasuya Inden, MD, PhD Toshihiko Yamamoto, MD Shinjiro Miyata, MD Masaya Fujita, MD Kenichiro Yokoi, MD Seifuku Kyo, MD Masayuki Shimano, MD, PhD Makoto Hirai, MD, PhD Toyoaki Murohara, MD, PhD A simple algorithm for localizing accessory pathways in patients with Wolff-Parkinson-White syndrome using only the R/S ratio Journal of Arrhythmia Wolff-Parkinson-White syndrome Accessory pathways R/S ratio Electrocardiogram Algorithm |
| title | A simple algorithm for localizing accessory pathways in patients with Wolff-Parkinson-White syndrome using only the R/S ratio |
| title_full | A simple algorithm for localizing accessory pathways in patients with Wolff-Parkinson-White syndrome using only the R/S ratio |
| title_fullStr | A simple algorithm for localizing accessory pathways in patients with Wolff-Parkinson-White syndrome using only the R/S ratio |
| title_full_unstemmed | A simple algorithm for localizing accessory pathways in patients with Wolff-Parkinson-White syndrome using only the R/S ratio |
| title_short | A simple algorithm for localizing accessory pathways in patients with Wolff-Parkinson-White syndrome using only the R/S ratio |
| title_sort | simple algorithm for localizing accessory pathways in patients with wolff parkinson white syndrome using only the r s ratio |
| topic | Wolff-Parkinson-White syndrome Accessory pathways R/S ratio Electrocardiogram Algorithm |
| url | http://www.sciencedirect.com/science/article/pii/S1880427613001658 |
| work_keys_str_mv | AT norikotaguchimd asimplealgorithmforlocalizingaccessorypathwaysinpatientswithwolffparkinsonwhitesyndromeusingonlythersratio AT naokiyoshidamdphd asimplealgorithmforlocalizingaccessorypathwaysinpatientswithwolffparkinsonwhitesyndromeusingonlythersratio AT yasuyaindenmdphd asimplealgorithmforlocalizingaccessorypathwaysinpatientswithwolffparkinsonwhitesyndromeusingonlythersratio AT toshihikoyamamotomd asimplealgorithmforlocalizingaccessorypathwaysinpatientswithwolffparkinsonwhitesyndromeusingonlythersratio AT shinjiromiyatamd asimplealgorithmforlocalizingaccessorypathwaysinpatientswithwolffparkinsonwhitesyndromeusingonlythersratio AT masayafujitamd asimplealgorithmforlocalizingaccessorypathwaysinpatientswithwolffparkinsonwhitesyndromeusingonlythersratio AT kenichiroyokoimd asimplealgorithmforlocalizingaccessorypathwaysinpatientswithwolffparkinsonwhitesyndromeusingonlythersratio AT seifukukyomd asimplealgorithmforlocalizingaccessorypathwaysinpatientswithwolffparkinsonwhitesyndromeusingonlythersratio AT masayukishimanomdphd asimplealgorithmforlocalizingaccessorypathwaysinpatientswithwolffparkinsonwhitesyndromeusingonlythersratio AT makotohiraimdphd asimplealgorithmforlocalizingaccessorypathwaysinpatientswithwolffparkinsonwhitesyndromeusingonlythersratio AT toyoakimuroharamdphd asimplealgorithmforlocalizingaccessorypathwaysinpatientswithwolffparkinsonwhitesyndromeusingonlythersratio AT norikotaguchimd simplealgorithmforlocalizingaccessorypathwaysinpatientswithwolffparkinsonwhitesyndromeusingonlythersratio AT naokiyoshidamdphd simplealgorithmforlocalizingaccessorypathwaysinpatientswithwolffparkinsonwhitesyndromeusingonlythersratio AT yasuyaindenmdphd simplealgorithmforlocalizingaccessorypathwaysinpatientswithwolffparkinsonwhitesyndromeusingonlythersratio AT toshihikoyamamotomd simplealgorithmforlocalizingaccessorypathwaysinpatientswithwolffparkinsonwhitesyndromeusingonlythersratio AT shinjiromiyatamd simplealgorithmforlocalizingaccessorypathwaysinpatientswithwolffparkinsonwhitesyndromeusingonlythersratio AT masayafujitamd simplealgorithmforlocalizingaccessorypathwaysinpatientswithwolffparkinsonwhitesyndromeusingonlythersratio AT kenichiroyokoimd simplealgorithmforlocalizingaccessorypathwaysinpatientswithwolffparkinsonwhitesyndromeusingonlythersratio AT seifukukyomd simplealgorithmforlocalizingaccessorypathwaysinpatientswithwolffparkinsonwhitesyndromeusingonlythersratio AT masayukishimanomdphd simplealgorithmforlocalizingaccessorypathwaysinpatientswithwolffparkinsonwhitesyndromeusingonlythersratio AT makotohiraimdphd simplealgorithmforlocalizingaccessorypathwaysinpatientswithwolffparkinsonwhitesyndromeusingonlythersratio AT toyoakimuroharamdphd simplealgorithmforlocalizingaccessorypathwaysinpatientswithwolffparkinsonwhitesyndromeusingonlythersratio |