A new algorithm for concealed accessory pathway localization using T-wave-subtracted retrograde P-wave polarity during orthodromic atrioventricular reentrant tachycardia.

Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing
Thomas RostockStephan Willems

Abstract

AP localization can be predicted by analyzing the polarity of the delta wave, QRS polarity, and R/S ratio in patients with Wolff-Parkinson-White syndrome. However, the estimation of AP location is limited in patients with concealed pathways during atrioventricular reentrant tachycardias (AVRT). Thus, we analyzed retrograde P-wave polarity during orthodromic AVRT and developed an algorithm to predict the localization of concealed accessory pathways (AP). A total number of 131 patients with a single AP and inducible orthodromic AVRT were included. The initial 61 patients were analyzed retrospectively for algorithm development, whereas 70 patients were evaluated prospectively. The retrograde P-wave polarity was analyzed by subtracting the superimposing T-wave during orthodromic AVRT using custom-designed software. Four leads of the surface electrocardiogram (ECG) were identified to accurately distinguish AP locations assigned to four different regions around each AV annulus: I, aVR, aVL, and V(1). Lead V(1) was used to differentiate right (negative or isoelectric) from left (solely positive) APs. Retrograde P-wave in lead I was negative in left posterior APs exclusively and became more positive with an AP location shifting towards...Continue Reading

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Citations

Jun 5, 2010·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·Dmitriy KireyevWilliam E Boden

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