COMPARISON OF ECG ALGORITHMS FOR IDENTIFYING ACCESSORY PATHWAY ABLATION SITE IN WOLFF-PARKINSON-WHITE SYNDROME

Abstract

Objective: To evaluate and compare the accuracy of two ECG algorithms in predicting accessory pathway location by comparing the final accessory pathway location after radiofrequency catheter ablation.

Study Design: A cross sectional study.

Pace and Duration of Study: The study was conducted at Armed Forces Institute of Cardiology & National Institute of Heart Diseases from January 2014 to December 2015

Material and Methods: A total of 120 patients with Wolf-Parkinson White syndrome were retrospectively analyzed by two independent electrophysiologists. The most pre-excited twelve lead ECG in sinus rhythm was used for analysis. Two algorithms were selected for comparing the accuracy of predicting accessory pathways. The Arruda ECG algorithm included delta wave polarity in its design while the Taguchi ECG algorithm included R/S ratio.

Results: Among all locations 55 (45.8%) were left sided and 65 (54.2%) were right sided. Out of total 120 accessory pathways, 14 (11.7%) were located in the midseptum or anteroseptum. In all, 105 (87.5%) predictions were correct for Arruda, and 94 (78.3%) for Taguchi. The predictive accuracy for Arruda algorithm based on delta wave was found to be significantly higher as compared to Taguchi algorithm based on R/S ratio (p 0.01). By combining the two algorithms, the cumulative predictive accuracy increased to 91.6%.

Conclusion: ECG algorithm based on delta wave morphology / polarity had better predictive accuracy in identifying the accessory pathway location in Wolf-Parkinson White syndrome.