JACC: Clinical Electrophysiology
Maximal Pre-Excitation Based Algorithm for Localization of Manifest Accessory Pathways in Adults
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Author + information
- Thomas Pambrun, MDa,b,∗ (thomaspambrun{at}aol.com),
- Rim El Bouazzaoui, MDa,
- Nicolas Combes, MDa,
- Stéphane Combes, MDa,
- Pedro Sousa, MDc,
- Mathieu Le Bloa, MDa,
- Grégoire Massoullié, MDb,
- Ghassen Cheniti, MDb,
- Ruairidh Martin, MDb,
- Xavier Pillois, PhDb,
- Josselin Duchateau, MDb,
- Frédéric Sacher, MD, PhDb,
- Mélèze Hocini, MDb,
- Pierre Jaïs, MDb,
- Nicolas Derval, MDb,
- Agustín Bortone, MDd,
- Serge Boveda, MDa,
- Arnaud Denis, MDb,
- Michel Haïssaguerre, MDb and
- Jean-Paul Albenque, MDa
- aDépartement de Rythmologie, Clinique Pasteur, Toulouse, France
- bHôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L’Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
- cCardiology Department, University Hospital of Coimbra, Coimbra, Portugal
- dService de Cardiologie, Hôpital Privé Les Franciscaines, Nîmes, France
- ↵∗Address for correspondence:
Dr. Thomas Pambrun, Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Avenue de Magellan, 33604 Pessac Cedex, France.
Graphical abstract
Abstract
Objectives This study evaluated a new algorithm relying on maximal pre-excitation.
Background Prior knowledge of accessory pathway (AP) location facilitates an individual ablation strategy. Delta-wave analysis on a 12-lead electrocardiogram is recognized as crucial for predicting ablation site, but can be ambiguous at basal state.
Methods An algorithm based on maximal pre-excitation, as induced by atrial pacing during an electrophysiological study, was initially developed in 132 patients with a single manifest AP. The maximally pre-excited QRS features included the global polarity in lead V1 (step 1), inferior leads (step 2), and leads V3 or I (step 3), as well as the morphology in lead II (step 4). Three investigators prospectively tested the new algorithm in 207 consecutive patients by comparing its efficacy to a control algorithm relying on basal pre-excitation.
Results The accuracy, defined as the percent of patients with an exact prediction of AP location, was significantly greater with the new algorithm (90% vs. 63%; p < 0.001). The reproducibility, defined as the level of agreement between investigators in determining AP location, was excellent (κ > 0.75; p < 0.05) with the new algorithm and fair (0.40 < κ < 0.75; p < 0.05) with the control algorithm.
Conclusions An algorithm based on maximal pre-excitation allows accurate and reproducible localization of manifest APs. When ablation is indicated, the analysis of maximal pre-excitation is a sensible approach for giving a head start in endocardial mapping.
Footnotes
This study received financial support from the French Government as part of the “Investments of the Future” program managed by the National Research Agency (ANR), Grant reference ANR-10-IAHU-04. Dr. Albenque has served as a consultant for Abbott, Biosense Webster, Inc., and ACT. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received February 5, 2018.
- Revision received March 6, 2018.
- Accepted March 29, 2018.
- 2018 American College of Cardiology Foundation
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