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Related Concept Videos

Electrocardiogram Fundamentals01:28

Electrocardiogram Fundamentals

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Introduction
An electrocardiogram (ECG) is a diagnostic tool for identifying cardiac conditions such as arrhythmias, conduction abnormalities, and myocardial ischemia.
Definition
An electrocardiogram (ECG) visualizes the heart's electrical activity by tracing the electrical movement associated with each heartbeat on a graph or monitor. As the heart beats, an electrical wave passes through it, correlating with the cardiac cycle events.
Parts of an ECG
An ECG utilizes electrodes on the skin...
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Correlation between ECG and Cardiac Cycle01:25

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The electrical signals recorded on an electrocardiogram (ECG) occur before the mechanical processes of contraction and relaxation during the cardiac cycle.
A cardiac action potential originates in the SA node and spreads throughout the atria and the AV node in approximately 0.03 seconds. This results in the P wave in an ECG and triggers atrial contraction. The action potential is then briefly slowed at the AV node, allowing the atria to contract and fill the ventricles with blood before...
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Related Experiment Video

Updated: Jul 1, 2025

Ablation of Ischemic Ventricular Tachycardia Using a Multipolar Catheter and 3-dimensional Mapping System for High-density Electro-anatomical Reconstruction
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EPM algorithm: A stepwise approach to accessory pathway localization in ventricular pre-excitation.

José Nunes de Alencar Neto1, Marcel Henrique Sakai2, Rogério Gomes de Almeida Neto2

  • 1Tele-Electrocardiography Division, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil; Universidade Federal de São Paulo, Escola Paulista de Medicina, Hospital São Paulo, São Paulo, Brazil.

Journal of Electrocardiology
|March 2, 2024
PubMed
Summary

The new EPM algorithm accurately localizes accessory pathways (APs) in patients with Wolff-Parkinson-White (WPW) syndrome, showing comparable results to existing methods. This systematic approach aids in electrophysiology treatment decisions.

Keywords:
Accessory pathwaysAlgorithmElectrocardiographyElectrophysiologyVentricular pre-excitation

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Area of Science:

  • Electrophysiology
  • Cardiology
  • Medical Diagnostics

Background:

  • Accurate accessory pathway (AP) localization is crucial for treating ventricular pre-excitation and Wolff-Parkinson-White (WPW) syndrome.
  • Current localization algorithms present diagnostic challenges, necessitating novel approaches.

Purpose of the Study:

  • To introduce and evaluate the diagnostic accuracy of the novel EPM algorithm for AP localization.
  • To compare the EPM algorithm's performance against established Arruda and EASY algorithms.

Main Methods:

  • Retrospective analysis of 138 patients undergoing catheter ablation at Hospital São Paulo.
  • Three blinded examiners assessed the EPM algorithm against Arruda and EASY algorithms.
  • Gold standard: Radioscopic AP position confirmed by disappearance of pre-excitation on ECG post-ablation.

Main Results:

  • EPM algorithm demonstrated diagnostic accuracy of 51.45%, comparable to Arruda (53.29%) and EASY (44.69%).
  • EPM showed high sensitivity (95.73%) for left vs. right APs and good adjacency accuracy (70.67%).
  • Excellent inter-observer variability for EPM (Kappa > 0.9) was observed, similar to other algorithms.

Conclusions:

  • The EPM algorithm is a reliable tool for AP localization, offering a systematic approach for electrophysiology.
  • Its diagnostic accuracy and excellent inter-observer reliability support its clinical applicability in guiding therapeutic decisions.
  • Further validation in broader clinical settings is recommended for the EPM algorithm.