Purpose

The correct estimation of accessory pathway (AP) localization from surface ECG is critical before the procedure. Our study aimed to detect the predictive value of the V1r + DIIq criterion for differentiating right- from left-sided paraseptal APs.

Methods

We retrospectively included 58 patients with (Wolff–Parkinson–White) WPW syndrome and paraseptal APs who underwent successful catheter ablation (37 male, 21 female; mean age 34.4 ± 13.6 years). The V1r + DIIq criterion was calculated using the following formula: V1r + DIIq (mV) = initial r wave amplitude in V1 + q wave amplitude in DII. The combined criterion included V1r + DIIq <2.05 mV and/or no initial r wave in V1.

Results

Right-sided paraseptal APs were detected in 36 patients (62.1%), left-sided paraseptal APs were detected in 21 patients (36.2%), and AP from CS was detected in 1 patient (1.7%). The initial r wave amplitude in V1 (mV), q wave amplitude in DII (mV) and V1r + DIIq criterion (mV) were lower in patients with right-sided paraseptal APs (p < 0.001). The percentage of patients with no initial r wave in V1 (36.1% vs. 0%) and those meeting the combined criterion (91.7% vs. 4.5%) were increased in patients with right-sided paraseptal APs. The cutoff value of the V1r + DIIq criterion obtained by ROC curve analysis was 2.05 mV for predicting right-sided paraseptal APs (sensitivity: 86.1%, specificity: 95.5%). The area under the curve (AUC) was 0.943 (95% CI = 0.881–1.000) (p < 0.001). The sensitivity and specificity values were 36.1% and 100%, respectively, for the no initial r wave criterion and 91.7% and 95.5%, respectively, for the combined criterion.

Conclusion

The V1r + DIIq criterion and the combined criterion represent novel and simple electrocardiographic criteria for accurately differentiating right- from left-sided paraseptal APs. This simple ECG measurement can improve the accuracy of detection of paraseptal AP localization and could be beneficial for decreasing ablation duration and radiation exposure.

中文翻译：

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V1r + DIIq 是一种新颖而准确的标准来预测右与左间隔旁旁通路

目的

从表面心电图正确估计辅助通路 (AP) 定位在手术前至关重要。我们的研究旨在检测 V1r + DIIq 标准对区分右侧和左侧间隔旁 AP 的预测价值。

方法

我们回顾性地纳入了 58 名 (Wolff-Parkinson-White) WPW 综合征和间隔旁 APs 患者，他们成功接受了导管消融术（37 名男性，21 名女性；平均年龄 34.4 ± 13.6 岁）。V1r + DIIq 标准使用以下公式计算：V1r + DIIq (mV) = V1 中的初始 r 波幅度 + DII 中的 q 波幅度。综合标准包括 V1r + DIIq <2.05 mV 和/或 V1 中无初始 r 波。

结果

36 例患者（62.1%）检测到右侧中隔旁 AP，21 例患者（36.2%）检测到左侧中隔旁 AP，1 例患者（1.7%）检测到来自 CS 的 AP。V1初始r波幅度（mV）、DII q波幅度（mV）和V1r+DIIq标准（mV）在右侧间隔APs患者中较低（p  < 0.001）。V1 初始无 r 波的患者百分比（36.1% 对 0%）和符合综合标准的患者百分比（91.7% 对 4.5%）在右侧间隔旁 AP 患者中增加。通过 ROC 曲线分析获得的 V1r + DIIq 标准预测右侧间隔 APs 的截止值为 2.05 mV（灵敏度：86.1%，特异性：95.5%）。曲线下面积 (AUC) 为 0.943 (95% CI = 0.881–1.000) ( p < 0.001)。无初始 r 波标准的敏感性和特异性值分别为 36.1% 和 100%，联合标准的敏感性和特异性值分别为 91.7% 和 95.5%。

结论

V1r + DIIq 标准和组合标准代表了新的和简单的心电图标准，用于准确区分右侧和左侧的间隔旁 AP。这种简单的心电图测量可以提高间隔旁 AP 定位检测的准确性，并且可能有利于减少消融持续时间和辐射暴露。