Localization of septal accessory pathways in WPW syndrome using simulated body surface potential maps as templates

Body surface potential maps (BSPMs) recorded during the delta wave in patients suffering from Wolff-Parkinson-White (WPW) syndrome can facilitate the localization of the site of accessory pathways. This study investigated the value of an anatomically accurate model of the human ventricular myocardium in simulating BSPMs that can be used as templates for discriminating among septal preexcitation sites. Preexcitation sequences were initiated at 12 sites at different regions of the basal septum; for each sequence, the authors calculated BSPMs at 2-ms increments within the first 40 ms after the onset of preexcitation. By inspecting the dominant morphological features of BSPM patterns, the authors established clinically applicable criteria for distinguishing between left and right posteroseptal preexcitation sites, between intermediate septal and anteroseptal or posteroseptal preexcitation sites, and between left and right anteroseptal preexcitation sites.