| Background:The Wolff-Parkinson-White Syndrome refers to an abnormal accessory atrioventricular pathway connecting the atrium and the ventricle that bypasses the atrioventricular normal conduction pathway(the atrioventricular node).Because the refractory period of the accessory pathway is shorter than that of the atrioventricular node,an impulse using this accessory pathways reaches the ventricle from the atrium faster than the one traveling the A-V node-His system.Nowdays,based on this anatomical feature,radiofrequency techniques for catheter ablation(RFCA)of accessory atrioventricular(AV)connections has become the radical treatment of pre-excitation syndrome,the success rate of surgery can reach more than 95%.Accurate localization of the accessory pathway before RFCA can help to guide the choice of ablation catheter,shorten the operation time,improve the success rate,and reduce the X-ray radiation time of the interventional doctor and patient.Different sites of the pathway of the Wolff-Parkinson-White syndrome have different manifestations on the 12-lead synchronized surface electrocardiogram(ECG).Therefore,according to the 12-lead ECG,the location of the accessory atrioventricular pathway on the annulus can be determined,which guide the radiofrequency catheter ablation.Since 1945,a large number of studies have shown that surface electrocardiogram has a high diagnostic value for locating the accessory pathway.There are a series of criteria for localization of the accessory pathway from the conventional surface electrocardiogram,but most of the criteria are cumbersome,complex and not good at clinical practice.Among them,the criteria developed by Arruda et al.is simple and accurate,with sensitivity of 90%and specificity of 99%.Its positive and negative rates was 93%and 98%respectively.In this study we received 116 patients with the pre-excitation syndrome to explore the sensitivity and specificity of this criteria.Objectives:The purpose of this study was to understand the clinical features of Wolff-Parkinson-White Syndrome and explore the accurateness of the criteria on the surface electrocardiogram.so as to better guide the RFCA,improve the success rate and shorten the X-ray exposure of both the doctors and patients.Methods:Totally 116 patients(66 males,50 females,average age 43 ± 16 years old)with The Wolff-Parkinson-White Syndrome who underwent RFCA in the department of cardiology of the first affiliated hospital of Soochow university from August 2015 to January 2019 were enrolled in this study.A 12-lead synchronized surface electrocardiogram during sinus rhythm was given for every patient.6-10 clear and stable cardiac cycles were recorded.The paper speed was 25 mm/s and the gain was 10mm/mv.On the one hand,all patients were divided into two groups according to the age:group A(<30 years old)and group B(?30 years old).On the other hand,according to the position of the accessory pathway,the patients divided into four groups:right free wall,left free wall,right interval and left interval.We analyzed them clinical characteristics,and the initial 20ms polarity of delta waves in the leads ?,?,aVF,V1,the R/S ratio of the QRS in the leads V1 and ? according to the criteria.Finally,we calculated the sensitivity,specificity,and accuracy of the criteria for localizing the accessory atrioventricular pathway.Results:There was no difference in gender in group A(male:female=15:17),and the male was more than the female in group B(male:female=51:33).The average age of onset of the left posterior septum was later than that of the other bypass(average age 47.3± 17.8 years old,P=0.047).Compared to the other parts,the left free wall had a longer PR interval and a shorter QRS interval.According to the radiofrequency ablation,a total of 48 patients were diagnosed as right side atrioventricular pathways,accounting for 41%,including 9 cases of Right anterior/right anterolateral,9 cases of Right lateral,11 cases of right posterior,3 cases of anteroseptal tricuspid annulus and right anterior paraseptal,1 cases of mid-septal tricuspid annulus,,the right posterior septum is 15 cases.There were 68 cases on the left side,accounting for 59%,including 46 cases of left anterior wall,8 cases of left posterior wall and 14 cases of left posterior septum.No subepicardial posteroseptal accessory pathways were seen in 116 patients.In our study,it showed a sensitivity of 82.8%,a specificity of 95.4%,and a correct rate of 92.2%for the right free wall,and demonstrated a sensitivity of 94.4%,a specificity of 91.8%,and a correct rate of 92.2%for the right interval walla About the left free wall,there are a sensitivity of 98.1%,a specificity of 91.9%and a correct rate of 94.8%.It showed the highest specificity(100.0%)in the left posterior septum,but its sensitivity was only 21.4%.In this study,The algorithm correctly identitied accessory pathway locations in 97 patients(sensitivity 85.5%,specificity 98.8%.positive predictive value 81.8%.negative predictive value 98.1%,and the correct rate 97.1%).When we excluded the left posterior septum,it demonstrated an overall sensitivity of 92.4%,a specificity of 99.2%,a positive predictive value of 93.5%,a negative predictive value of 99,0%,,and a correct rate of 98.4%.Conclusion:The standard of Arruda has a high accuracy for the right and left free wall accessory pathway and the right septum accessory pathway,and a poor accuracy for the left posterior septum accessory pathway. |
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