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\begin{document}

\title{Accessory pathway localization with probabilistic density maps generated
by a mobile application: Validation of a full preexcitation net-vector
method}



\author[1]{Marek Jastrzebski}%
\author[2]{Kamil Fijorek}%
\author[3]{Piotr Futyma}%
\author[4]{Michal Orczykowski}%
\author[5]{Maciej Pitak}%
\author[3]{Łukasz Zarębski}%
\author[3]{Piotr Sajdak}%
\author[5]{Sebastian Góreczny}%
\author[4]{Łukasz Szumowski}%
\author[1]{Rajzer Marek}%
\author[6]{Pawel Moskal}%
\affil[1]{Uniwersytet Jagiellonski w Krakowie I Klinika Kardiologii i Nadcisnienia Tetniczego}%
\affil[2]{Uniwersytet Ekonomiczny w Krakowie}%
\affil[3]{Uniwersytet Rzeszowski}%
\affil[4]{National Institute of Cardiology}%
\affil[5]{Uniwersytet Jagiellonski w Krakowie Collegium Medicum}%
\affil[6]{Szpital Uniwersytecki w Krakowie}%


\vspace{-1em}



  
  \date{May 23, 2024}


\begingroup
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\selectlanguage{english}
\begin{abstract}
\textbf{Introduction.} Precise electrocardiographic localization of
accessory pathways (AP) can be challenging. Seminal AP localization
studies were limited by complexity of algorithms and sample size.We
aimed to create a non-algorithmic method for AP localization based on
color-coded maps of AP distribution generated by a web-based
application. \textbf{Methods.} APs were categorized into 19
regions/types based on invasive electrophysiologic mapping. Preexcited
QRS complexes were categorized into 6 types based on polarity and
notch/slur. For each QRS type in each lead the distribution of APs was
visualized on a gradient map. The principle of common set was used to
combine the single lead maps to create the distribution map for AP with
any combination of QRS types in several leads. For the validation phase,
a separate cohort of APs was obtained. \textbf{Results.} A total of 804
patients with overt APs were studied. The application used the
exploratory dataset of 552 consecutive APs and the corresponding QRS
complexes to generate AP localization maps for any possible combination
of QRS types in 12 leads. Optimized approach (on average 3 steps) for
evaluation of preexcited ECG was developed. The area of maximum
probability of AP localization was pinpointed by providing the QRS type
for the subsequent leads. The exploratory dataset was validated with the
separate cohort of APs (n = 260); p = 0.23 for difference in AP
distribution. \textbf{Conclusions.} In the largest dataset of APs
to-date, a novel probabilistic and semi-automatic approach to
electrocardiographic localization of APs was highly predictive for
anatomic localization.%
\end{abstract}%



\sloppy


\textbf{Introduction.}

Catheter ablation is an important curative therapy for arrhythmias and
sudden cardiac death caused by accessory pathways (AP). (1-3) An
important part of catheter ablation is precise electrocardiographic
localization of AP localization along the mitral and tricuspid annuli.
AP capable of orthodromic conduction influences QRS morphology by
preexciting the adjacent ventricular myocardium. The preexcited QRS
configuration depends on the localization of the AP and the degree of
preexcitation. Those observations form the foundation of all ECG based
methods for APs localization.

Precise electrocardiographical localization of AP remains an elusive
goal. Despite various complex algorithms that were developed over the
last three decades, accuracy is suboptimal - as demonstrated by several
independent validation studies. (4-9) Moreover, those detailed
algorithms are difficult to remember and follow which further limits
their practical application. The inherent limitation of all AP
algorithms stems from the fact that the AP regions used by the
algorithms are categorical, rather than along a spectrum. The same
applies to ECG features such as QRS polarity or delta wave polarity,
which do not follow binary categorization. Furthermore, uniform 12 ECG
lead placement cannot compensate for the variability in heart position
within the chest and oblique APs. Therefore, it is unrealistic to expect
that some combination of QRS morphologies in 12 ECG leads will precisely
identify a particular AP region in a 0 vs. 1 fashion.

We hypothesized that 12-lead ECG QRS morphology patterns point to a
region of possible AP locations, albeit with identification of the
anatomic sites with highest probability.

\textbf{Aims}

To develop and validate a novel and non-algorithmic and semi-automatic
method for AP localization based on colour-coded gradient maps that
indicate the probability of AP localization.

To propose an optimized stepwise approach to preexcited ECG by a
net-vector analysis - supported by the web-based mobile application.

\textbf{Methods}

The study was conducted according to the Helsinki declaration and was
approved by local bioethical committee.

\emph{Population}

The purpose of the exploratory phase was to build a web-based
application capable of generating representative density maps of AP
localization. Consecutive patients who underwent AP ablation in two
centres over a 17-year period (2001-2018) were retrospectively screened.
Patients with concealed preexcitation, poor ECG quality, uncertain
ablation site or unsuccessful ablation were excluded.

\emph{Categorization of accessory pathway regions/types}

The AP categorization is illustrated by the diagram on \textbf{Figure
1}and explained in detail below. For anatomic localization of the
ablation site, fluoroscopic imaging or electroanatomic 3D maps were used
in various projections, especially the left anterior oblique projection
of 35 degree (LAO).

\begin{itemize}
\tightlist
\item
  Parahisian (PHIS) localization was diagnosed when a His bundle
  potential was recorded at the site of successful ablation.
\item
  Right midseptal (RMS) region was defined as below the PHIS region and
  above the roof of the coronary sinus ostium.
\item
  Right posteroseptal (RPS) region was defined as below the roof of the
  coronary sinus ostium, including the periostial region (but less than
  1 cm inside the coronary sinus) and extending to 5.00 o'clock on the
  tricuspid annulus in LAO.
\item
  Right posterior (RP) region was defined as between 5.00 and 7.00
  o'clock on the tricuspid annulus in LAO.
\item
  Right posterolateral (RPL) region was defined as between 7.00 and 8.00
  o'clock on the tricuspid annulus in LAO.
\item
  Right lateral region (RL) region was defined as between 8.00 and 10.00
  o'clock on the tricuspid annulus in LAO.
\item
  Right anterolateral (RAL) region was defined as between 10.00 and
  11.00 o'clock on the tricuspid annulus in LAO.
\item
  Right anterior (RA) region was defined as between 11.00 and 12.30
  o'clock on the tricuspid annulus in LAO.
\item
  Right anteroseptal (RAS) region was defined as between 12.30 o'clock
  on the tricuspid annulus in LAO and the PHIS region.
\item
  Epicardial (EPI) AP was diagnosed when the successful ablation had to
  be performed within the coronary sinus (\textgreater{} 1 cm from the
  ostium) including cardiac veins and coronary sinus diverticula.
\item
  Atriofascicular (MAHAIM) AP was diagnosed per the recognized
  electrophysiological criteria for such AP, regardless of the actual
  position of successful ablation site on the tricuspid annulus.
\item
  Fasciuloventricular (FASC-VENT) AP was diagnosed with HV \textless{}
  35 ms and fixed preexcitation during incremental pacing, adenosine
  administration and/or extrastimulus testing.
\item
  Left midseptal (LMS) AP was diagnosed when successful ablation was on
  the mitral anulus just below the His bundle potential region --
  corresponding in LAO to the right midseptal region.
\item
  Left posteroseptal (LPS) region was defined as just below the aorta on
  the mitral annulus between 7.00 -- 8.00 o'clock in LAO.
\item
  Left posterior (LP) region was defined as between 5.00 -- 7.00 o'clock
  on the mitral annulus in LAO.
\item
  Left posterolateral (LPL) region was defined as between 4.00 -- 5.00
  o'clock on the mitral annulus in LAO.
\item
  Left lateral (LL) region was defined as between 2.00 -- 4.00 o'clock
  on the mitral annulus in LAO.
\item
  Left anterolateral (LAL) region was defined as between 12.30 -- 2.00
  o'clock on the mitral annulus in LAO.
\item
  Left anterior (LA) region (including aortomitral continuity), was
  defined as between 11.00-12.30 o'clock on the mitral annulus in LAO.
\end{itemize}

\emph{ECG assessment}

For each patient, ECG with baseline preexcitation and/or ECG with full
preexcitation were analysed (per availability). Full preexcitation ECG
pattern was obtained during electrophysiological study via incremental
atrial pacing, programmed atrial pacing or adenosine administration. QRS
polarity/type was coded as one of the six following categories:
completely positive (monophasic R) without notches, completely positive
(R) with notches (notch/plateau at the top of monophasic R wave),
predominantly positive (Rs, Rsr', qR etc.), equiphasic (RS, QRS, RSR',
etc.), predominantly negative (Qr, rS, rSr', etc.) or completely
negative (QS) - depending on the dominant polarity. Examples of QRS
categories are presented in \textbf{Figure 2} and inside the application
next to each question. Most representative full preexcitation patterns
for the 19 regions are illustrated in \textbf{Figure 3} and
Supplementary \textbf{Figures 1-2} .

\emph{Mobile web-based application (WPW24.com)}

Each AP region, and all QRS types in all 12 leads, separately for the
full and baseline preexcitation patterns, were coded and introduced into
the application database to enable automatic cross-correlation between
AP localization and QRS morphology. A web-based application (WPW24.com),
optimized for mobile devices was developed. The WPW24.com is a client
side only progressive web app implemented with React and TypeScript. The
application enabled to graphically show changing distribution of APs
with regard to the introduced by the user, at each step, the QRS type in
a particular ECG lead. Providing the QRS type for the subsequent ECG
leads, pinpoints, in a stepwise manner, the area of maximum probability
of AP localization (\textbf{Figures 4 - 6} and \textbf{Supplementary
Video} \textbf{1)} . User can choose his/her own criteria/steps; there
is no need to adhere to any steps or order of assessment of ECG leads.
Both baseline and fully preexcited ECG can be used for map generation -
per user preference. Each question regarding morphology is provided with
a support -- graphical illustration of several QRS types that are
compatible with that QRS morphology category.

\emph{Proposed steps of ECG assessment to localize AP}

Optimized steps for ECG analysis were added to the WPW24.com app to
increase its functionality. These steps were developed on the basis of
the classic rules of ECG interpretation and the personal experience of
over 1000 APs ablated by the first author. Most of these criteria, in
various modifications, can be found in the literature, (10-17) the only
authorial criterion is QRS notch/slur/plateau (\textbf{Figure 2} ) to
differentiate right free wall pathways from septal pathways. The steps
for ECG analysis were optimized by post-hoc assessment - if a step did
not result in an expected differentiating change of AP distribution
pattern -- it was abandoned and other were explored. Following rules
were tested to build the pathways for analysis of preexcited ECG:

\begin{enumerate}
\tightlist
\item
  Positive or equiphasic V1 indicates left free wall and left septal AP;
  conversely, negative V1 indicates right free wall and right septal AP
\item
  Precordial transition to positive/equiphasic QRS at V2 -- V4 indicates
  right septal AP; while precordial transition \textgreater{} V4 suggest
  right free wall or Mahaim AP
\item
  Negative II, III, aVF indicate posterior AP, positive II, III, AVF
  indicate anterior AP, while mixed polarity in these leads suggest
  sites in-between (i.e. lateral free-wall or midseptal). In such
  scenario, right free wall pathways are favored by the presence of a
  notch/slur/plateau in leads I, aVL, aVF or V6.
\item
  Completely positive lead I indicates right or septal AP. Contrarywise,
  the more negative the QRS in lead I (the deeper the S wave) the more
  to the left is the AP, with completely negative complex (QS
  morphology) indicating the most left sided region -- i.e. left lateral
  location.
\end{enumerate}

\emph{Statistics}

Continuous variables are presented as means and standard deviations.
Categorical variables are presented as percentages. Comparison of APs
distribution patterns between groups were made using the Ch2 and
Wilcoxon tests. Weighted Kappa-statistic was used to assess the
inter-observer agreement. Statistical analyses were performed using
STATA 18 (StataCorp, Texas, USA). P-values \textless{} 0.05 were
considered statistically significant.

\emph{Validation}

Since the outcome of the WPW24.com based ECG analysis does not point to
a single AP location but to a spectrum of anatomic locations with a
gradient of probability -- validation of the method in a traditional
manner (i.e., the predicted site vs. the site of successful ablation)
was not feasible. Even apparently very odd AP locations (for a
particular QRS pattern) suggested by the WPW24.com might be validated as
correct when a sizable number of APs, that included such rare variants,
is analysed. Therefore, to validate WPW24.com, we examined whether the
distribution of APs used by the application to generate the maps is
representative. Validation of distribution patterns was performed only
for the full preexcitation as inherently more precise. For this,
comparison of AP distribution in the exploratory cohort that was used by
the application with the AP distribution in two external cohorts was
made. The first dataset used for validation was obtained from new
patients studied in years 2018-2023 in four centres. The second dataset
for validation of AP distribution was obtained from the seven published
studies that proposed new AP localization algorithms. The validation
phase was commenced once the work on the web-based application, and the
exploratory cohort, were completed.

\textbf{Results}

A total of 804 consecutive patients (age: 30.9 \selectlanguage{ngerman}± 18.6 years; male:
58.6\%) with overt preexcitation were studied. These patients provided
547 with baseline preexcitation and 769 ECGs with full preexcitation.

\emph{Exploratory and validation phases}

The first 546 consecutive patients provided dataset of AP localization
and QRS morphology types in 12 leads including 509 ECGs with full
preexcitation and 547 ECGs with baseline preexcitation that were
furnished to the WPW24.com database. Distribution of all APs in that
cohort is presented in \textbf{Figure 1} and \textbf{Table 1} .
Illustrative examples of how QRS polarity in a single ECG lead impacts
distribution of APs along mitral and tricuspid annuli is presented
in\textbf{Figure 5 and 6} . Depending on the AP type/localization there
were 2 to 5 optimized steps for ECG analysis\textbf{.} To reach the
final diagnosis/distribution map a mean 3.0 +/-steps per ECG were
needed.

For validation, the dataset of 260 ECGs were used, 49\% of these ECGs
were obtained prospectively, after the exploratory phase. The remaining
51\% were obtained retrospectively albeit from a new centre that did not
participate in the exploratory phase. Distribution of all APs in the
exploratory and validation phases is presented in \textbf{Figure 1}
and\textbf{Table 1} -- no differences in the distribution of APs between
the exploratory and validation datasets were found (p = 0.263).

To compare the exploratory cohort with the data from the literature a
simplified categorization of AP regions had to be applied since the
categorization and regions in every study are different, sometimes
poorly defined and often with overlap of different regions among
studies, making direct detailed comparison impossible
(\textbf{Supplementary Table 1} ). However, when all AP were grouped
into four major categories (right free wall, left free wall, right
posteroseptal and other septal) no difference in the distribution of AP
among the exploratory cohort and the pooled cohort from the seven
published studies (n = 1252), was present, p = 0.24.

\emph{Baseline and maximal preexcitation}

Both baseline and full preexcitation based ECG analysis were implemented
in WPW24.com to enhance its functionality. However, the baseline
preexcitation maps showed wider spread of regions than full
preeexcitation maps indicating lower value of fused QRS vectors for AP
localization. For formal comparison of baseline and full preexcitation
AP distribution maps three differentiating QRS polarities were chosen:
lead V1 negative/predominantly negative, lead I positive/predominantly
positive, lead III positive/predominantly positive. For each of these
polarities APs distribution were compared between baseline and full
preexcitation confirming differences in distribution (p \textless{}
0.05); for visual assessment see \textbf{Supplementary Figure 3\emph{.}}

\emph{Miscellaneous}

A total of 50 consecutive ECGs were analysed by a second observer.
Interobserver agreement of QRS polarity assessment was very high
(agreement 94.27\%, kappa 0.8931, and standard error 0.033, p
\textless{} 0.0001).

\textbf{Discussion}

The major results of the study were as below:

\begin{enumerate}
\tightlist
\item
  The method for AP localization with AP distribution gradient maps --
  separate for any specified 12-lead preexcited QRS pattern was
  developed and supported by a dedicated mobile application.
\item
  The hypothesis that a particular 12-lead QRS morphology pattern will
  point to a wider area of possible AP locations, rather than to a
  single location was verified with the observed AP distribution
  patterns in a large cohort.
\item
  Optimized stepwise approach for analysis of preexcited ECG was
  developed.
\end{enumerate}

\emph{Comparison with the algorithmic methods for AP localization}

Majority of AP localization algorithms were based on a limited number of
cases, often partially pre-selected. For example, the sample size was
120, 157, 140, 135, 93 and 148 in Ferrari et al., Boersma et al, D'Avila
et al., Arruda et al., Fitzpatrick et al., and Millstein et al.
algorithms, respectively. (10-13;15;16) Small sample size can create an
illusion that a particular QRS pattern is 100\% specific for some
location -- as it is not seen at other AP locations. However, a bigger
sample might show that other cases with the same ECG pattern had
successful ablation at other locations as well. The current study, based
on the largest cohort of overt AP ever studied, fully supports the
concept that preexcited ECG pattern does not point to a particular
location but rather reflects a wider area, albeit with the site of
maximum AP frequency surrounded by a probability gradient.
Representative illustration of this phenomenon can be found
on\textbf{Supplementary Figure 4} , which presents outcomes of analysis
of the same ECG with the D'Avila algorithm and with WPW24.com app.

Algorithms are trying to create an ideal match between AP location and
QRS pattern. Imperfections of that match are covered by algorithm's
sensitivity and specificity. Several independent validation studies
showed that sensitivity/specificity/accuracy of algorithmic methods are
lower than initially reported. These studies are in agreement with the
current results, because low accuracy of an algorithm indicates that the
APs were not limited to the single predicted locations but probably
there was a wider spread of APs. Consequently, algorithmic methods are a
somewhat misleading by creating an illusion of single location even when
their sensitivity, specificity and accuracy are low - indicating
contrariwise. In contrast, WPW24.com, instead of pretending precision
and pointing to one location is showing where the accessory pathways
were actually ablated in all studied cases with the QRS pattern that is
similar or identical to the one with which the current patient had
presented.

Almost all algorithms are based on the analysis of baseline preexcited
ECG, occasionally, on `most preexcited' baseline ECG -- that is on a QRS
morphology that results from fusion between native conduction and AP
conduction. That might be another reason for the divergence between the
original studies and the independent validation studies -- as the degree
of preexcitation for the same localization varies and it is impossible
to determine how much preexcited ECGs were used in the original study.
Full preexcitation pattern maximizes the localizing information
contained in the preexcited QRS polarity because the confounding impact
of conduction via His-Purkinje system on QRS is nearly eliminated.
Moreover, full preexcitation standardizes the ECG patterns for
comparison between studies. It was shown in our previous work that using
fully preexcited ECG increases accuracy of AP localization, even for
algorithms that were designed for analysis of baseline preexcitation.
(6)

\emph{Clinical translation}

Operators are nowadays more familiar with 3D colour-coded gradient maps
than with preexcitation patterns in ECG. A tool that supports AP
localization in a familiar fashion, with color-coded gradient map that
covers the mitral and tricuspid rings, may be a more descriptive and
predictive method to enhance utility of standard 12-lead ECG for the
assessment and treatment of WPW cases. Moreover, the WPW24.com app has a
substantial educational potential by illustrating the relationship
between changing morphology of QRS and the related changes in AP
distribution along the tricuspid and mitral annuli (\textbf{Figures 6
and Supplementary Figure 1} ).

Algorithms are often complex, introduce subjectivity with binary
categorizations, and are difficult to memorize. The polarity of the
initial 20 ms of the delta wave, used in several algorithms, is often
difficult to discern and has significant inter-observer variability. In
our experience, algorithms are rarely followed in real life practice,
but physicians rather use simple set of rules, similar to these on which
the current method was based. The WPW24.com addresses these limitations
by being readily available to any smartphone or tablet user without the
need to memorize anything. And, by being based on the QRS polarity (net
vector) - a feature so easy to ascertain, especially with the provided
inside app examples of different QRS configurations that are compatible
with a particular category (\textbf{Figure 2} ), makes the preexcited
ECG analysis straightforward.

Use of an algorithm, that indicates one particular AP location, can fix
the operator on undue pursuit of ablation in that region even when
multiple energy applications were not successful. A gradient map by
being more honest with regard to the possible AP locations, while
directing to the most probable area as well, gives also clues what other
locations should be explored in the next steps. For example, even quite
typical ECG pattern for RPS site (QRS transition to positive at V2,
negative II) is sometimes seen with AP at RMS, RP, LMS, LPS, and EPI
locations.

WPW24.com can be seen as a tool for memory enhancement and sharing of
experience. A small-volume AP ablationist might have never experienced
or likely does remember a patient ablated several years ago, that had a
rare preexcited ECG pattern that was identical to the ECG of the patient
currently on the table. Yet that pattern could be an excellent clue to
the localization of the AP that is undergoing ablation. Illustration of
such scenario that occurred during the current study is presented
in\textbf{Figure 1} and \textbf{Supplementary Video 1} . In the future,
WPW24.com database can be expanded by adding datasets of consecutive APs
from other centers, getting as close as possible to making precise
diagnosis of AP type/location via full 12-lead QRS pattern recognition.

\emph{Limitations}

Given the non-categorical and non-algorithmic nature of our probability
maps - direct comparison with other methods was not possible. Moreover,
it was not possible to quantify accuracy and traditional test
characteristics like specificity and sensitivity.

\textbf{Conclusions}

A novel method for electrocardiographic localization of APs, based on a
probabilistic approach and semi-automatic analysis of QRS patterns from
the largest to-date cohort of overt AP is predictive, accurate, with
high reproducibility. Anatomic localization that is based on
probabilistic gradient maps of AP distribution may be more accurate than
historical categorizations.

\textbf{Funding}

The study was supported by the PTK SENIT grant number K/DAR/000001

\textbf{Acknowledgments}

We gratefully acknowledge the assistance of Roderick Tung in reviving
and preparing the final manuscript.



\textbf{Figures and legends}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image1/image1}

\end{center}
\end{figure}

\textbf{Figure 1.} Categorization of accessory pathway (AP)
regions/types. This is the baseline probability map of AP localization
that is the starting point of ECG interpretation - before any QRS
morphology data is considered by the WPW24.com application. The
percentages correspond to the distribution of all AP in the full
preexcitation cohort - hence the fasciculo-ventricular pathways, not
capable to fully preexcite the ventricles, are not counted here. For
explanation of the abbreviations and the definitions of AP types/regions
see text.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image2/image2}

\end{center}
\end{figure}

\textbf{Figure 2} . Six categories of fully preexcited QRS morphology.
Regardless of the number of deflections in QRS, the overall polarity is
defined by the dominant deflection, e.g. rSr is a predominantly negative
QRS. Equiphasic QRS is diagnosed when none of the deflections is
\textgreater{} 2 mm than the other.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image3/image3}

\end{center}
\end{figure}

\textbf{Figure 3} . Representative examples of fully preexcited QRS
complexes of accessory pathways ablated from the left side. Most lateral
sites (LA, LAL, LL, LPL) are characterized by QS/rS in lead I and high
amplitude V1, Contrariwise, septal/paraseptal sites (LP, LPS, LMS) have
R/RS wave in lead I and often small amplitude/multiphasic QRS in V1.
Lead aVF differentiates between superior (R) and inferior locations
(QS/rS). Representative examples of fully preexcited QRS complexes of
accessory pathways ablated from the right side are in Supplementary
Figures 1 and 2. For abbreviations see text.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image4/image4}

\end{center}
\end{figure}

\textbf{Figure 4.} Illustration of the ECG analysis via WPW24.com
application at the beginning of the ablation procedure. Left panel: the
fully preexcited QRS is obtained with fast atrial pacing. At steps 1-4
the information regarding QRS morphology is introduced into the
application. \emph{Step 1} : predominantly negative V1 nearly eliminates
the left sided access accessory pathways (AP), only small admixture of
left septal APs remains, the point of maximum is now at the most common
right-sided region i.e. right posteroseptal (RPS). \emph{Step 2} :
predominantly negative QRS in V2 now eliminates the possibility of left
sided APs and makes RPS AP relatively unlikely, shifting the point of
maximum probability to the parahisian region (PHIS) and adjoining right
anteroseptal (RAS) region, but many other right-sided locations are also
possible. \emph{Step 3} : equiphasic QRS in V3 lowers the chances of a
right free wall AP and shifts the focus to septal pathways as 50\% of
possible APs are now at the PHIS or RAS regions. \emph{Step 4} :
predominantly positive aVF, intuitively, should eliminate posterior
pathways (RPS, RMS, RP i RPL), but it does more than that: it identifies
a rare QRS pattern that was seen only 3 times per 509 APs and in all
those three cases (from the exploratory cohort) the successful ablation
was in the PHIS region. In this fourth case analysed, (from the
validation cohort) the successful ablation (left panels) was also in the
PHIS region.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image5/image5}

\end{center}
\end{figure}

\textbf{Figure 5.} The impact of fully preexcited QRS morphology in lead
I fully on the distribution of accessory pathways (APs). Positive V1 at
the \emph{STEP 1} changes the pretest AP distribution by eliminating
almost all right-sided APs, only a small admixture of right-sided septal
APs remains. At the \emph{STEP 2} : QRS morphology in lead I has to be
provided. With increasing negativity of the QRS in lead I, the maximum
probability site shift progressively to the left. A QS complex in lead I
identifies left lateral (LL) AP, with 86.4\% of all such APs ablated at
that region, while R complex in lead I eliminates the possibility of LL
AP and shifts point of maximum probability to the left posterior
location (LP, 40.7\%); common alternative sites are the adjacent left
posteroseptal (LPS, 35.2\%) and septal/epicardial (23\%). With Rs or RS
complex one more step is necessary to reach the final diagnosis, while
with R, rS or QS complex the second step is the final step.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image6/image6}

\end{center}
\end{figure}

\textbf{Figure 6.} Impact of fully preexcited QRS morphology in lead aVF
on the distribution of accessory pathways (APs) in patients with
transition from negative QRS to positive QRS at V3. The right panel
illustrates how, first with the disappearance of notch/slur the
localization of APs shifts from the free wall to the septum, and then,
with increasing negativity in lead aVF the point of maximum density
shifts progressively more inferiorly on the septum (maps from the top to
the bottom in the right panel).

\textbf{Table 1} . Distribution of overt accessory pathways (AP) among
regions/types in the current study and the literature.\selectlanguage{english}
\begin{longtable}[]{@{}lllllllllll@{}}
\toprule
\begin{minipage}[b]{0.09\columnwidth}\raggedright\strut
AP region\strut
\end{minipage} & \begin{minipage}[b]{0.09\columnwidth}\raggedright\strut
Current study all n = 808\strut
\end{minipage} & \begin{minipage}[b]{0.09\columnwidth}\raggedright\strut
Exploratory cohort n = 552\strut
\end{minipage} & \begin{minipage}[b]{0.09\columnwidth}\raggedright\strut
Validation cohort n = 256\strut
\end{minipage} & \begin{minipage}[b]{0.09\columnwidth}\raggedright\strut
Milstein n = 148\strut
\end{minipage} & \begin{minipage}[b]{0.09\columnwidth}\raggedright\strut
Ferrari n =120\strut
\end{minipage} & \begin{minipage}[b]{0.09\columnwidth}\raggedright\strut
Arruda n = 256\strut
\end{minipage} & \begin{minipage}[b]{0.09\columnwidth}\raggedright\strut
Pambrun n = 339\strut
\end{minipage} & \begin{minipage}[b]{0.09\columnwidth}\raggedright\strut
D'Avila n = 139\strut
\end{minipage} & \begin{minipage}[b]{0.09\columnwidth}\raggedright\strut
Fitzpatrick n = 93\strut
\end{minipage} & \begin{minipage}[b]{0.09\columnwidth}\raggedright\strut
Boersma n = 157\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Parahisian\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
5.2 (42)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
5.8 (32)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
3.9 (10)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
7.4 (25)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
7.6 (12)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Right midseptal\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
7.8 (63)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
7.8 (43)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
7.8 (20)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
31.8 (47)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
15 (18)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
3.5 (9)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
7.2 (10)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
7.5 (7)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
8.3 (13)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Right posteroseptal\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
18.9 (153)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
17.4 (96)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
22.3 (57)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
13 (16)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
17.6 (45)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
17.7 (60)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
21.6 (30)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
18.3 (17)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
17.8 (28)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.09\columnwidth}\raggedright\strut
Right posterior\strut
\end{minipage} & \begin{minipage}[t]{0.09\columnwidth}\raggedright\strut
2.5 (20)\strut
\end{minipage} & \begin{minipage}[t]{0.09\columnwidth}\raggedright\strut
3.1 (17)\strut
\end{minipage} & \begin{minipage}[t]{0.09\columnwidth}\raggedright\strut
1.2 (3)\strut
\end{minipage} & \begin{minipage}[t]{0.09\columnwidth}\raggedright\strut
3.4 (5)\strut
\end{minipage} & \begin{minipage}[t]{0.09\columnwidth}\raggedright\strut
1.5 (2)\strut
\end{minipage} & \begin{minipage}[t]{0.09\columnwidth}\raggedright\strut
2.3 (6)\strut
\end{minipage} & \begin{minipage}[t]{0.09\columnwidth}\raggedright\strut
6.8 (23)\strut
\end{minipage} & \begin{minipage}[t]{0.09\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.09\columnwidth}\raggedright\strut
9.7 (9)\strut
\end{minipage} & \begin{minipage}[t]{0.09\columnwidth}\raggedright\strut
19.7 (31)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Right posterolateral\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
2.1 (17)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
2.4 (13)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
1.6 (4)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
3.1 (8)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
7.9~(11)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Right lateral\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
2.3 (19)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
1.8 (10)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
3.5 (9)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
5 (6)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
7.0 (18)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
2.4 (8)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Right anterolateral\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
2.6 (21)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
2.7 (15)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
2.3 (6)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
4 (5)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
2.7 (7)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
12.9 (12)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Right anterior\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
2.1 (17)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
2.0 (11)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
2.3 (6)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
3 (4)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
7.0 (18)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
5.0 (17)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
5.1 (8)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Right anteroseptal\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
2.2 (18)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
2.7 (15)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
1.2 (3)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
13.5 (20)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
12 (15)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
6.2 (16)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
18.0 (25)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
11.8 (11)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Epicardial\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
2.6 (21)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
2.2 (12)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
3.5 (9)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
8.2 (21)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
2.1 (8)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
1.3 (2)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Atriofascicular\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
2.0 (16)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
2.2 (12)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
1.6 (4)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Fasciuloventricular\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
1.4 (11)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
2.0 (11)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Left midseptal\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
0.7 (6)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
0.5 (3)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
1.2 (3)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Left posteroseptal\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
5.3 (43)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
4.5 (25)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
7.0 (18)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
51.4 (76)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
11 (13)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
4.2 (11)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
12.4 (42)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
7.9 (11)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
5.4 (5)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
10.2 (16)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Left posterior\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
8.8 (71)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
10.0 (55)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
6.2 (16)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
3 (3)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
2.3 (6)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
5.0 (7)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
14.0 (13)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Left posterolateral\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
8.0 (65)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
6.5 (36)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
11.3 (29)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
6 (7)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
5.9 (15)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
14.1 (48)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
29.9 (47)\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Left lateral\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
22.9 (185)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
24.6 (136)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
19.1 (49)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
24 (29)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
18.7 (48)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
31.9 (108)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
32.4 (45)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
20.4 (19)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Left anterolateral\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
1.9 (15)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
1.3 (7)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
3.1 (8)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
2 (2)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
10.9 (28)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
Left anterior\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
0.6 (5)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
0.5 (3)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
0.8 (2)\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
-\strut
\end{minipage} & \begin{minipage}[t]{0.07\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

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