Department of Cardiology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey.
Department of Cardiology, Hatay Mustafa Kemal University, Faculty of Medicine, Hatay, Turkey.
J Electrocardiol. 2022 Jan-Feb;70:30-34. doi: 10.1016/j.jelectrocard.2021.11.028. Epub 2021 Nov 23.
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.
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.
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.
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.
在进行手术前，正确估计旁路（AP）的体表心电图定位至关重要。我们的研究旨在检测 V1r+DIIq 标准区分右侧和左侧间隔旁 AP 的预测价值。
我们回顾性纳入了 58 例（Wolff-Parkinson-White）WPW 综合征合并间隔旁 AP 并成功接受导管消融的患者（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 初始 r 波幅度+DII 中 q 波幅度。联合标准包括 V1r+DIIq<2.05 mV 和/或 V1 中无初始 r 波。
36 例（62.1%）患者检测到右侧间隔旁 AP，21 例（36.2%）患者检测到左侧间隔旁 AP，1 例（1.7%）患者检测到 CS 旁 AP。右侧间隔旁 AP 患者 V1 初始 r 波幅度（mV）、DII 中 q 波幅度（mV）和 V1r+DIIq 标准（mV）均较低（p<0.001）。右侧间隔旁 AP 患者 V1 中无初始 r 波的患者比例（36.1% vs. 0%）和符合联合标准的患者比例（91.7% vs. 4.5%）增加。ROC 曲线分析得到 V1r+DIIq 标准的截断值为 2.05 mV，用于预测右侧间隔旁 AP（敏感性：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分别为 36.1%和 100%，联合标准的敏感性和特异性分别为 91.7%和 95.5%。
V1r+DIIq 标准和联合标准是一种新颖、简单的心电图标准，可准确区分右侧和左侧间隔旁 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，并可能有助于减少消融时间和辐射暴露。
