Spatial vectorcardiography in the Wolff-Parkinson-White syndrome: correlation with epicardial mapping findings

The spatial vectorcardiograms (VCG) of 13 patients with WPW syndrome due to single accessory pathways were analyzed and correlated with the excitation analysis obtained on epicardial mapping. The azimuth angle of the initial 10 ms cardiac vector was greater than + 90 degrees (directed right and anteriorly) in patients with a left ventricular free wall; it ranged between 0 degree to 90 degrees (left and anteriorly) in those with a left or right paraseptal free wall and was -30 degrees (left and posteriorly) in one patient with a right ventricular free wall location. The elevation angle of the initial 10 and 20 ms cardiac vector was either zero or positive (inferiorly directed) in those with right and left ventricular free wall pathway. Among six patients with a paraseptal location, the elevation angle was negative (superiorly directed) in four and positive in two. Both the patients with a clockwise inscription of a QRS loop in the horizontal plane (HP) had pathways located to the left ventricle. Among the paraseptal group, at surgery, the accessory pathway could not be excised in two in spite of dissection very close to the IV (interventricular) septum. The elevation angle in both these patients was markedly negative (-45 degrees and -62 degrees) in contrast to the other in whom surgical excision was successful.+