Nakagawa Ryo, Sato Kazuhisa, Yoshida Yoko, Suzuki Tsugutoshi, Nakamura Yoshihide
Division of Pediatric Electrophysiology, Pediatric Medical Care Center, Osaka City General Hospital, Osaka, Japan.
Pacing Clin Electrophysiol. 2025 Jan;48(1):114-118. doi: 10.1111/pace.15114. Epub 2024 Nov 27.
Wolff-Parkinson-White (WPW) syndrome and fasciculoventricular pathway (FVP) present electrocardiographic manifestations characterized by delta waves, differentiating these two is challenging. Specifically, WPW type B with QRS width ≤120 ms, resembles typical FVP features. Because of the presence of repolarization abnormalities in WPW syndrome, our hypothesis centered on the potential utility of the QRS-T angle for distinguishing WPW syndrome from FVP. To determine the discriminative value of the QRS-T angle for delineating WPW syndrome from FVP.
We included cases of WPW syndrome treated with catheter ablation and FVP diagnosed via adenosine triphosphate administration between 2007 and 2023. We excluded cases with WPW type A, QRS width >120 ms, intermittent WPW, congenital heart disease or myocardial damage, ablation history, tachycardia, palpitations within 3 months, and WPW syndrome featuring an accessory pathway on the left lateral wall. Eventually, we identified 40 and 54 patients from the WPW and FVP groups, respectively. The QRS-T angle was compared between the WPW and FVP cohorts.
The QRS-T angle in the WPW group was significantly larger than in the FVP group (45.7 ± 46.3° vs. 17.8 ± 13.9°, p < 0.001). Receiver operating characteristic curve analysis with a sensitivity and specificity of 65.0% and 72.6%, respectively, demonstrated that the optimal cut-off value for the QRS-T angle was 22° for distinguishing WPW from FVP. Remarkably, all cases with a QRS-T angle >65° were within the WPW group.
The QRS-T angle can offer promising utility in differentiating WPW syndrome from FVP.
Wolff-Parkinson-White（WPW）综合征和分支室室旁道（FVP）均表现为以δ波为特征的心电图表现，区分这两者具有挑战性。具体而言，QRS波宽度≤120 ms的B型WPW类似于典型的FVP特征。由于WPW综合征存在复极异常，我们的假设集中在QRS-T角对于区分WPW综合征和FVP的潜在效用上。以确定QRS-T角在区分WPW综合征和FVP方面的鉴别价值。
我们纳入了2007年至2023年间接受导管消融治疗的WPW综合征病例以及通过静脉注射三磷酸腺苷诊断的FVP病例。我们排除了A型WPW、QRS波宽度>120 ms、间歇性WPW、先天性心脏病或心肌损伤、有消融病史、心动过速、3个月内有心悸以及左侧壁存在附加旁道的WPW综合征病例。最终，我们分别从WPW组和FVP组中确定了40例和54例患者。比较了WPW组和FVP组之间的QRS-T角。
WPW组的QRS-T角显著大于FVP组（45.7±46.3°对17.8±13.9°，p<0.001）。受试者工作特征曲线分析显示，QRS-T角区分WPW和FVP的最佳截断值为22°，灵敏度和特异度分别为65.0%和72.6%。值得注意的是，所有QRS-T角>65°的病例均在WPW组内。
QRS-T角在区分WPW综合征和FVP方面可能具有很大的效用。
