{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T23:09:08Z","timestamp":1782601748845,"version":"3.54.5"},"reference-count":23,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2015,7,16]],"date-time":"2015-07-16T00:00:00Z","timestamp":1437004800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2015,9]]},"abstract":"<jats:title>New ECG Criteria for Left\u2010Sided AV Connections<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Accessory AV\u2010connections capable of antegrade conduction need to be recognized because of the potential for life\u2010threatening arrhythmias. However, the preexcited ECG pattern may be subtle, especially among left\u2010sided AV\u2010connections. We explored whether additional ECG criteria might help identify left\u2010sided AV\u2010connections.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed 156 patients who underwent an electrophysiology study (EPS) and ablation for paroxysmal supraventricular tachycardias (PSVT). Patients were divided into 2 groups: those with left\u2010sided AV\u2010connections (Group 1) and all other PSVT (Group 2). Various ECG parameters were compared before and after ablation in both groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The EPS identified left\u2010sided AV\u2010connections among 43 patients (Group 1) and excluded it among 113 (Group 2). Baseline ECG in Group 1 demonstrated obvious preexcitation among 24\/43 patients (55.8%), the remaining 19\/43 missing obvious preexcitation. R\/S ratio &gt; 0.5 in V1 was noted in 38\/43 (88.4%) patients in Group 1 before ablation (median 1.00; IQR 0.58\u20132.20), including 16\/19 (84.2%) patients lacking obvious left\u2010sided AVconnections. Conversely, only 10\/113 (8.8%) patients in Group 2 had R\/S ratios in V1 \u2265 0.5 (0.20; 0.10\u20100.31), P &lt; 0.0001. After ablation, the R\/S ratio decreased significantly in Group 1 (0.29; 0.17\u20130.45), P &lt; 0.0001. Thus, a combined criterion of classic preexcitation or R\/S ratio \u2265 0.5 on ECG identified 40\/43 left\u2010sided AV\u2010connections (sensitivity 93.0%). The negative predictive value of this combined criterion was 103\/106 (97.2%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In symptomatic patients, combining the R\/S ratio (\u2265 0.5) in lead V1 with the classic preexcitation pattern on ECG markedly improved the sensitivity to diagnose left\u2010sided AV\u2010connections. This ratio may be particularly useful among patients lacking obvious preexcitation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.12711","type":"journal-article","created":{"date-parts":[[2015,5,20]],"date-time":"2015-05-20T10:09:52Z","timestamp":1432116592000},"page":"978-984","source":"Crossref","is-referenced-by-count":3,"title":["A Practical ECG Criterion to Unmask Left Accessory AV Connections in Patients With Subtle Preexcitation"],"prefix":"10.1111","volume":"26","author":[{"given":"J. JENKINS","family":"THOMPSON","sequence":"first","affiliation":[{"name":"Virginia Commonwealth University  Richmond Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JIGNESH","family":"SHAH","sequence":"additional","affiliation":[{"name":"University of Kentucky Gill Heart Institute and VAMC, Cardiology  Lexington Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"RICHARD","family":"CHARNIGO","sequence":"additional","affiliation":[{"name":"University of Kentucky Gill Heart Institute and VAMC, Cardiology  Lexington Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ANDREA","family":"TACKETT","sequence":"additional","affiliation":[{"name":"University of Kentucky Gill Heart Institute and VAMC, Cardiology  Lexington Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"YOUSEF H.","family":"DARRAT","sequence":"additional","affiliation":[{"name":"University of Kentucky Gill Heart Institute and VAMC, Cardiology  Lexington Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ALISON","family":"BAILEY","sequence":"additional","affiliation":[{"name":"University of Kentucky Gill Heart Institute and VAMC, Cardiology  Lexington Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"BRIAN","family":"DELISLE","sequence":"additional","affiliation":[{"name":"University of Kentucky Gill Heart Institute and VAMC, Cardiology  Lexington Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"BAHRAM","family":"KAKAVAND","sequence":"additional","affiliation":[{"name":"University of Kentucky Gill Heart Institute and VAMC, Cardiology  Lexington Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"LUIGI","family":"DI BIASE","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute at St. David's Medical Center  Austin Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ANDREA","family":"NATALE","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute at St. David's Medical Center  Austin Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"GUSTAVO","family":"MORALES","sequence":"additional","affiliation":[{"name":"University of Kentucky Gill Heart Institute and VAMC, Cardiology  Lexington Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CLAUDE S.","family":"ELAYI","sequence":"additional","affiliation":[{"name":"University of Kentucky Gill Heart Institute and VAMC, Cardiology  Lexington 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