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Europace Advance Access published online on November 9, 2009
Europace, doi:10.1093/europace/eup345
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

CLINICAL RESEARCH

A new approach to confirming or excluding ventricular pre-excitation on a 12-lead ECG

Martin Eisenberger1,4,*, Neil Colin Davidson2, Derick Michael Todd3, Clifford John Garratt1 and Adam Paul Fitzpatrick1

1 Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; 2 North West Regional Cardiac Centre, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK; 3 Liverpool Heart and Chest Hospital NHS Trust, Liverpool, Thomas Drive, Liverpool L14 3PE, UK; 4 International Clinical Research Centre, Pekarska 53, 656 91 Brno, Czech Republic

Aims: The purpose of this study was to determine simple features of the standard 12-lead electrocardiogram (ECG) and incorporate them in a stepwise algorithm that would help confirm or exclude the presence of ventricular pre-excitation.

Methods and results: We retrospectively analysed multiple variables on pre- and post-ablation ECGs in 238 patients with manifest accessory pathways that had been successfully ablated. A new variable, PR dispersion, was defined as a difference between maximum and minimum PR intervals on a single 12-lead ECG. A logistic regression analysis showed the combination of the following criteria to be powerful in the confirmation of the diagnosis in patients with suspected delta wave: presence of both PR interval ≤120 ms and PR dispersion ≥20 ms, absence of initial positive deflection (septal R wave) in lead augmented voltage right arm (aVR), and horizontal QRS transition in lead V1 or before. A stepwise algorithm was developed based on these criteria. Of the total 476 ECGs, seven patients with pre-excitation and one patient with normal ECG were misdiagnosed using the algorithm. Even though the retrospectively determined sensitivity and specificity of the three stepwise criteria were high (97% and 99%, respectively) a prospective study evaluating the algorithm is needed.

Conclusion: Using a stepwise approach is a very sensitive and specific technique for excluding or confirming ventricular pre-excitation on a 12-lead ECG.

Key Words: Pre-excitation, 12-lead ECG, Radiofrequency ablation, PR dispersion, Septal waves

* Corresponding author. Tel: +44 161 276 5545, Fax: +44 161 276 8911, Email: martineisenberger{at}hotmail.com

Manuscript submitted 13 July 2009. Accepted after revision 12 October 2009.


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