Comparison between Three Algorithms in Predicting the Location of Accessory Pathway by 12 Lead Surface ECG in Wolff-Parkinson-White Syndrome Patients

Background: Wolff-Parkinson-White (WPW) syndrome, a pre-excitation condition that develops in 0.1-0.3% of the overall population, is brought on by the existence of an accessory atrioventricular circuit. With varied levels of difficulty and accuracy, many algorithms have been put forward for localizing accessory pathway (AP) utilizing 12-lead ECG analysis. This study aimed to compare between three algorithms in predicting where the accessory circuit is located in individuals with Wolff-Parkinson-White syndrome using a 12-lead surface ECG guided by successful ablation site.

Methods: The research included 100 people with Wolff-Parkinson-White syndrome and was prospective cross-sectional in design. The patients were presented to the arrhythmia clinics at the Cardiology Departments in Tanta University Hospitals and Ain Shams University Hospitals (El-Demerdash hospital) and who were planned for electrophysiological study and radiofrequency ablation between July 2019 and July 2021. The ECG was analyzed and compared using the three selected algorithms and fluoroscopy was used to identify the location of a successful ablation at the time of catheter ablation. A complete electrophysiological study was done for exact localization of the accessory pathway.

Results: No major difference between the three algorithms in total accuracy was found, but as regard different AP locations, there was difference in sensitivity and specificity for each location between the three algorithms.

Conclusions: Arruda & d'Avila's approach was the most effective at predicting left-sided accessory pathways, while d'Avila then our proposed algorithm were the best algorithms for prediction of accessory pathways at right-sided. The best algorithms for detection of anteroseptal and mid-septal accessory pathways were our proposed algorithm and Arruda.