A Single‐lead ECG algorithm to differentiate right from left manifest accessory pathways: A reappraisal of the P‐Delta interval

Despite numerous ECG algorithms being developed to localize the site of manifest accessory pathways (AP), they often require stepwise multiple‐lead analysis with variable accuracy, limitations, and reproducibility. The study aimed to develop a single‐lead ECG algorithm incorporating the P‐Delta interval (PDI) as an adjunct criterion to discriminate between right and left manifest AP.

[1]  Jeroen J. Bax,et al.  2019 ESC Guidelines for themanagement of patients with supraventricular tachycardia , 2020 .

[2]  L. Lo,et al.  A Novel and Simple Algorithm Using Surface Electrocardiogram That Localizes Accessory Conduction Pathway in Wolff-Parkinson-White Syndrome in Pediatric Patients. , 2019, Acta Cardiologica Sinica.

[3]  Vassilios J. Bezzerides,et al.  Differentiation of fasciculoventricular fibers from anteroseptal accessory pathways using the surface electrocardiogram. , 2019, Heart rhythm.

[4]  F. Sacher,et al.  Maximal Pre-Excitation Based Algorithm for Localization of Manifest Accessory Pathways in Adults. , 2018, JACC. Clinical electrophysiology.

[5]  Chun-Min Fu,et al.  Study on ECG in the Adolescent , 2018, Pediatric Cardiology.

[6]  H. Kabul,et al.  Electrocardiographic estimation of successful ablation site in patients with manifest inferior paraseptal accessory pathway. , 2016, Journal of electrocardiology.

[7]  B. Açar,et al.  Comparison of the accuracy of three algorithms in predicting accessory pathways among adult Wolff-Parkinson-White syndrome patients , 2015, Journal of Interventional Cardiac Electrophysiology.

[8]  J. Bourke,et al.  Accuracy of algorithms to predict accessory pathway location in children with Wolff–Parkinson–White syndrome , 2011, Heart.

[9]  A. Skanes,et al.  How to identify the location of an accessory pathway by the 12-lead ECG. , 2008, Heart Rhythm.

[10]  C. Berul,et al.  Inaccuracy of Wolff‐Parkinson‐White Accessory Pathway Localization Algorithms in Children and Patients with Congenital Heart Defects , 2006, Journal of cardiovascular electrophysiology.

[11]  David F Dickinson,et al.  The normal ECG in childhood and adolescence , 2005, Heart.

[12]  F. Cosío,et al.  Atrial Activation Mapping in Sinus Rhythm in the Clinical Electrophysiology Laboratory: , 2004, Journal of cardiovascular electrophysiology.

[13]  L. Michalis,et al.  Localization of Accessory Pathways by the Electrocardiogram: , 2004, Pacing and clinical electrophysiology : PACE.

[14]  Lluís Mont,et al.  Accessory Pathway Localization by QRS Polarity in Children with Wolff‐Parkinson‐White Syndrome , 2002, Journal of cardiovascular electrophysiology.

[15]  M. Messier,et al.  Accuracy and Limitations of Published Algorithms Using the Twelve‐Lead Electrocardiogram to Localize Overt Atrioventricular Accessory Pathways , 1999, Journal of cardiovascular electrophysiology.

[16]  L. Widman,et al.  Development and Validation of an ECG Algorithm for Identifying Accessory Pathway Ablation Site in Wolff‐Parkinson‐White Syndrome , 1998, Journal of cardiovascular electrophysiology.

[17]  L. Colín,et al.  A new ECG algorithm for the localization of accessory pathways using only the polarity of the QRS complex. , 1996, Journal of electrocardiology.

[18]  J. Brugada,et al.  A Fast and Reliable Algorithm to Localize Accessory Pathways Based on the Polarity of the QRS Complex on the Surface ECG During Sinus Rhythm , 1995, Pacing and clinical electrophysiology : PACE.

[19]  C. Tai,et al.  An accurate stepwise electrocardiographic algorithm for localization of accessory pathways in patients with Wolff-Parkinson-White syndrome from a comprehensive analysis of delta waves and R/S ratio during sinus rhythm. , 1995, The American journal of cardiology.

[20]  A. Camm,et al.  Localization of accessory pathways from the 12-lead electrocardiogram using a new algorithm. , 1994, The American journal of cardiology.

[21]  R. Cardinal,et al.  Comparative accuracy of the vectorcardiogram and electrocardiogram in the localization of the accessory pathway in patients with Wolff-Parkinson-White syndrome: validation of a new vectorcardiographic algorithm by intraoperative epicardial mapping and electrophysiologic studies. , 1990, American heart journal.

[22]  Arjun D. Sharma,et al.  An Algorithm for the Electrocardiographic Localization of Accessory Pathways in the Wolff‐Parkinson‐White Syndrome , 1987, Pacing and clinical electrophysiology : PACE.

[23]  Paul D. White,et al.  Bundle‐Branch Block with Short P‐R Interval in Healthy Young People Prone to Paroxysmal Tachycardia , 1930 .

[24]  P. Moskal,et al.  Increased preexcitation on electrocardiography improves accuracy of algorithms for accessory pathway localization in Wolff–Parkinson–White syndrome , 2020 .

[25]  A. Fitzpatrick,et al.  A new approach to confirming or excluding ventricular pre-excitation on a 12-lead ECG. , 2010, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[26]  A. Fitzpatrick,et al.  New algorithm for the localization of accessory atrioventricular connections using a baseline electrocardiogram. , 1994, Journal of the American College of Cardiology.

[27]  J. Odier,et al.  Time relationship of the P-delta segment in the Wolff-Parkinson-White syndrome. , 1978, Journal of electrocardiology.