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Can we improve the accuracy of electrocardiographic algorithms for accessory pathway location in children?

Paola Ferrari1, Giovanni Malanchini1, Marco Racheli1, Gabriele Ferrari1, Cristina Leidi1, Paolo Cerea, Michele Senni2, Paolo Della Bella3, Maurizio Malacrida4, Simone Gulletta3, Paolo De Filippo1
DOI: 10.33963/KP.a2021.0167
·
Pubmed: 34856632
Affiliations
  1. Elettrofisiologia e Elettrostimolazione cardiaca, ASST Papa Giovanni XXIII, Bergamo, Italy
  2. Cardiologia 1, ASST Papa Giovanni XXIII, Bergamo, Italy
  3. Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Scientific Institute, Milan, Italy
  4. Boston Scientific, Milan, Italy

open access

Online first
Original article
Published online: 2021-12-01

Abstract

Background: Predicting accessory pathway location is extremely important in pediatric patients. We designed a study to compare previously published algorithms by Arruda, Boersma and Chiang.

Material and methods: This multi-center study included patients who had undergone successful ablation of one accessory pathway. Analysis of resting 12-lead electrocardiograms was carried out. An aggregated prediction score was constructed on the basis of algorithm agreement, and a structured workflow approach was proposed.

Results: The total population was of 120 patients (mean age = 12.7 [3.6] years). The algorithm by Boersma had the highest accuracy (71.7%). The inter-rater agreement among the 3 reference algorithms, according to left-sided accessory pathway (AP) identification, was good between Boersma and Chiang (k = 0.611; 95% CI, 0.468–0.753) but moderate between Arruda and Chiang and between Arruda and Boersma (k = 0.566; 95% CI, 0.419–0.713 and k = 0.582; 95% CI, 0.438–0.727, respectively). Regarding locations at risk of atrioventricular (AV) block, agreement was fair between Arruda and Chiang and between Boersma and Chiang (k = 0.358; 95% CI, 0.195–0.520 and kappa = 0.307; 95% CI, 0.192–0.422, respectively), but moderate between Arruda and Boersma (kappa = 0.45; 95% CI, 0.304–0.597). On applying a first-step diagnostic evaluation, when concordance was achieved, we were able to correctly identify left-sided or non-left-sided ablation sites in 96.4% (n = 80) of cases; when concordance was achieved, correct prediction of risk/no risk of AV block was achieved in 92.2% (n = 59) of cases.

Conclusions: An aggregated prediction score based on 3 reference algorithms proved able to predict accessory pathway location very precisely and could be used to safely plan invasive procedures.

Abstract

Background: Predicting accessory pathway location is extremely important in pediatric patients. We designed a study to compare previously published algorithms by Arruda, Boersma and Chiang.

Material and methods: This multi-center study included patients who had undergone successful ablation of one accessory pathway. Analysis of resting 12-lead electrocardiograms was carried out. An aggregated prediction score was constructed on the basis of algorithm agreement, and a structured workflow approach was proposed.

Results: The total population was of 120 patients (mean age = 12.7 [3.6] years). The algorithm by Boersma had the highest accuracy (71.7%). The inter-rater agreement among the 3 reference algorithms, according to left-sided accessory pathway (AP) identification, was good between Boersma and Chiang (k = 0.611; 95% CI, 0.468–0.753) but moderate between Arruda and Chiang and between Arruda and Boersma (k = 0.566; 95% CI, 0.419–0.713 and k = 0.582; 95% CI, 0.438–0.727, respectively). Regarding locations at risk of atrioventricular (AV) block, agreement was fair between Arruda and Chiang and between Boersma and Chiang (k = 0.358; 95% CI, 0.195–0.520 and kappa = 0.307; 95% CI, 0.192–0.422, respectively), but moderate between Arruda and Boersma (kappa = 0.45; 95% CI, 0.304–0.597). On applying a first-step diagnostic evaluation, when concordance was achieved, we were able to correctly identify left-sided or non-left-sided ablation sites in 96.4% (n = 80) of cases; when concordance was achieved, correct prediction of risk/no risk of AV block was achieved in 92.2% (n = 59) of cases.

Conclusions: An aggregated prediction score based on 3 reference algorithms proved able to predict accessory pathway location very precisely and could be used to safely plan invasive procedures.

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Keywords

pre-excitation, WPW, algorithm, pediatric, children

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Title

Can we improve the accuracy of electrocardiographic algorithms for accessory pathway location in children?

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2021-12-01

DOI

10.33963/KP.a2021.0167

Pubmed

34856632

Keywords

pre-excitation
WPW
algorithm
pediatric
children

Authors

Paola Ferrari
Giovanni Malanchini
Marco Racheli
Gabriele Ferrari
Cristina Leidi
Paolo Cerea
Michele Senni
Paolo Della Bella
Maurizio Malacrida
Simone Gulletta
Paolo De Filippo

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