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Localization of Accessary Pathway by Ecg
Localization of Accessary Pathway by Ecg
PATHWAY BY ECG
INTRODUCTION
POSTERIOR ANTERIOR
QRS transition is the most significant variable and delta wave amplitude
in lead II can assist to discriminate where the first variable is equivocal.
If the transition is between V3 & V4 then look for the amplitude of delta
wave in lead II; if it is equal or more than 1 mV then septal location
otherwise lateral location (97% sensitivity & 95% specificity).
Right Anteroseptal vs. Right Posteroseptal vs. Right
Mid Septal
Delta wave polarities in leads II, Ill and aVF is the most significant variable.
Delta wave frontal plane axis is the most significant variable and if this is
equivocal the R wave amplitude in lead III.
If the delta wave frontal plane axis is equal or more than zero, then the
pathway location is at anterolateral site otherwise it is at posterolateral
location (92% sensitivity, 100% specificity).
Arruda aproach
If the the delta wave in lead aVF is isoelectric or negative then the
accessory pathway is located at the left posterior or posterolateral region
Step 2: lead II is examined.
If the delta wave is isoelectric in lead aVF, the accessory pathway may be
located to either the posteroseptal tricuspid annulus or the posteroseptal
mitral annulus.
A positive delta wave in aVF identifies a pathway located within the
anteroseptal/right anterior paraseptal or midseptal tricuspid annulus
regions .
If the delta wave in V1 is positive after having excluded patients with a left
free-wall accessory pathway in Step 1, a right free wall accessory AV
pathway is identified.
Proceed to Step 4.
Step 4: In patients with a right free –wall accessory pathways, examine aVF.