Localization of accessory pathways from the 12-lead electrocardiogram using a new algorithm
B Xie, SC Heald, Y Bashir, D Katritsis… - The American journal of …, 1994 - Elsevier
B Xie, SC Heald, Y Bashir, D Katritsis, FD Murgatroyd, AJ Camm, E Rowland, DE Ward
The American journal of cardiology, 1994•ElsevierA new algorithm (St. George's algorithm), based on the polarity and morphology of QRS
complexes rather than delta waves, was developed for localizing accessory pathways to 1 of
9 sites on the atrioventricular annuli. This was compared with algorithms previously
proposed by Skeberis et al (localizing to 1 of 7 sites) and Milstein et al (localizing to 1 of 4
sites). The preexcited 12-lead electrocardiograms recorded during sinus rhythm in 106
consecutive patients (including 60 retrospectively analyzed patients and 46 prospectively …
complexes rather than delta waves, was developed for localizing accessory pathways to 1 of
9 sites on the atrioventricular annuli. This was compared with algorithms previously
proposed by Skeberis et al (localizing to 1 of 7 sites) and Milstein et al (localizing to 1 of 4
sites). The preexcited 12-lead electrocardiograms recorded during sinus rhythm in 106
consecutive patients (including 60 retrospectively analyzed patients and 46 prospectively …
Abstract
A new algorithm (St. George's algorithm), based on the polarity and morphology of QRS complexes rather than delta waves, was developed for localizing accessory pathways to 1 of 9 sites on the atrioventricular annuli. This was compared with algorithms previously proposed by Skeberis et al (localizing to 1 of 7 sites) and Milstein et al (localizing to 1 of 4 sites). The preexcited 12-lead electrocardiograms recorded during sinus rhythm in 106 consecutive patients (including 60 retrospectively analyzed patients and 46 prospectively analyzed patients) who underwent successful radiofrequency catheter ablation of a single accessory pathway were analyzed by 3 blinded observers using all 3 algorithms. The results were compared with the actual localization of accessory pathways as derived from endocardial mapping during catheter ablation. In all 106 patients, the accuracy of the 3 algorithms for 4 sites on the atrioventricular annuli (as considered by Milstein's method) was 72%, 79%, and 92% for Milstein's, Skeberis', and St. George's algorithms, respectively. For 7 sites (as considered by Skeberis' method), the accuracy was 65% (Skeberis' algorithm) and 88% (St. George's algorithm), and for 9 sites (as considered by our method) the accuracy was 86% (St. George's algorithm). In 46 prospectively analyzed patients, the accuracy of the 3 algorithms for 4 sites was 70% (Milstein's), 67% (Skeberis'), and 87% (St. George's); for 7 sites the accuracy was 61% (Skeberis') and 85% (St. George's), and for 9 sites the accuracy was 85% (St. George's). The reproducibility of St. George's and Skeberis' methods was better than that of Milstein's method. It is concluded that our algorithm allows localization of a single accessory pathway from the preexcited 12-lead electrocardiogram with sufficient precision and greater accuracy than other methods.
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