Accuracy of Algorithms Predicting Accessory Pathway Localization in Pediatric Patients with Wolff-Parkinson-White Syndrome

Abstract

We aimed to assess the accuracy of determining accessory pathway (AP) localization from 12 lead ECG tracings by applying 12 different algorithms in pediatric patients diagnosed with Wolff-Parkinson-White syndrome. We compared algorithm accuracy in electrophysiologic study ECG tracings with full preexcitation and resting ECG tracings. The assessing pediatric cardiologists were blinded regarding EP study results on AP localization. For exact AP location, the algorithms published by D'Avila et al. and Boersma et al. yielded the highest accuracy (58%). Distinguishing laterality, the median accuracy for predicting left or right-sided APs was 74%, while for septal APs it was 68%. We conclude that algorithms predicting AP location in pediatric patients with Wolff-Parkinson-White syndrome show low accuracy for exact AP localization. For laterality, however, accuracy was significantly higher.

Keywords: ECG; WPW syndrome; ablation; electrophysiology; pathway localization.

Figure 1

Prediction accuracy for laterality from 12 lead resting ECG tracings and ECG tracings with full ventricular preexcitation during EPS.

Figure 2

ECG tracings from a patient with a left posterolateral AP. (A) 12 lead resting ECG tracing with manifest preexcitation (50 mm/s). (B) 12 lead ECG tracing during atrial pacing in EPS shows a full ventricular preexcitation pattern (100 mm/s).