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Algorithm

EASY-WPW algorithm

Localizes the accessory pathway starting from V1: three steps for right-sided pathways (tricuspid valve) and two for left-sided pathways (mitral valve).

Step 1

V1: polarity?

Limitation

An estimate based on surface ECG morphology. It does not replace the electrophysiology study for definitive pathway localization.

A tool to support learning and decision-making. The result does not replace clinical evaluation of the patient.

About: EASY-WPW algorithm

EASY-WPW localizes the manifest accessory pathway starting from V1: QRS polarity in that lead separates tricuspid (right-sided) from mitral (left-sided) pathways. Then the precordial transition and the lead with the most positive delta wave define the region.

It was designed to be simple and to work in both children and adults.

How to use

  1. Step 1: check whether the QRS in V1 is negative or isoelectric (right-sided pathway) or positive (left-sided pathway).
  2. Right-sided pathways: check whether the QRS transition occurs by V3 and which lead has the most positive delta wave.
  3. Left-sided pathways: identify the lead with the most positive delta wave.

How to interpret

  • The result is one of four regions: anteroseptal, posteroseptal, anterolateral or posterolateral.

Limitations

Like any surface ECG algorithm, it depends on obvious pre-excitation and loses accuracy with multiple pathways or subtle pre-excitation. Definitive localization is made in the electrophysiology study.

References

  1. El Hamriti M, Braun M, Molatta S, et al. EASY-WPW: a novel ECG-algorithm for easy and reliable localization of manifest accessory pathways in children and adults. Europace. 2023.