Accuracy and Limitations of Published Algorithms Using the Twelve‐Lead Electrocardiogram to Localize Overt Atrioventricular Accessory Pathways

Basiouny, Tarek; Chillou, Christian de; Fareh, Samir; Kirkorian, Gilbert; Messier, Marc; Sadoul, Nicolas; Chevalier, P; Magnin‐Poull, Isabelle; Blankoff, Ivan; Chen, Jian; Touboul, P; Aliot, Étienne

doi:10.1111/j.1540-8167.1999.tb00189.x

Cited by 29 publications

(10 citation statements)

References 36 publications

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“…This fact, common to the study of Wren et al., 9 was also observed in a study by Moraes et al, 10 in which the agreement rates obtained with the application of different algorithms in a sample of 190 patients with WPW syndrome proved to be substantially below those published by the authors of each algorithm (including, among others, the algorithm by Iturralde et al with an agreement rate of 54.7%). Similar findings were obtained in a study published by Basiouny et al, 23 which compared 11 algorithms applied to 266 ECGs of patients with WPW syndrome. These researchers found significantly lower results for those algorithms with more than six possible locations for the AP.…”

Section: Discussionsupporting

confidence: 85%

Accuracy of the Electrocardiogram in Localizing the Accessory Pathway in Patients with Wolff-Parkinson-White Pattern

Teixeira¹,

Pereira²,

Lebreiro

et al. 2016

Arquivos Brasileiros De Cardiologia

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BackgroundThere are currently several electrocardiographic algorithms to locate the accessory pathway (AP) in patients with Wolff-Parkinson-White (WPW) syndrome.ObjectiveTo compare the ability of electrocardiographic algorithms in identifying the location of the AP in patients with WPW pattern referred for ablation.MethodsObservational, cross-sectional, retrospective study with 111 patients with WPW syndrome referred for AP ablation. The electrocardiogram (ECG) obtained prior to the ablation was analyzed by an experienced observer who consecutively applied seven algorithms to identify non-invasively the AP. We then compared the location estimated with this assessment with that obtained in the electrophysiological study and calculated the agreement rates.ResultsAmong the APs, 59 (53.15%) were distributed around the mitral annulus and the remaining 52 (46.85%) were located around the tricuspid annulus. The overall absolute accuracy of the algorithms evaluated varied between 27% and 47%, increasing to between 40% and 76% when we included adjacent locations. The absolute agreement rate by AP location was 2.00-52.20% for septal APs (n = 51), increasing to 5.90-90.20% when considering adjacent locations; 7.70-69.20% for right APs (n = 13), increasing to 42.90-100% when considering adjacent locations; and 21.70-54.50% for left APs (n = 47), increasing to 50-87% when considering adjacent locations.ConclusionThe agreement rates observed for the analyzed scores indicated a low discriminative ability of the ECG in locating the AP in patients with WPW.

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Section: Discussionsupporting

confidence: 85%

Accuracy of the Electrocardiogram in Localizing the Accessory Pathway in Patients with Wolff-Parkinson-White Pattern

Teixeira¹,

Pereira²,

Lebreiro

et al. 2016

Arquivos Brasileiros De Cardiologia

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“…Basiouny et al found significantly lower results for algorithms with more than six possible locations for the AP. 16 …”

Section: Discussionmentioning

confidence: 99%

EASY-WPW: a novel ECG-algorithm for easy and reliable localization of manifest accessory pathways in children and adults

et al. 2022

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Aims Accessory pathway (AP) ablation is a standard procedure for the treatment of Wolff-Parkinson-White syndrome (WPW). Twelve-lead electrocardiogram (ECG)-based delta wave analysis is essential for predicting ablation sites. Previous algorithms have shown to be complex, time-consuming, and unprecise. We aimed to retrospectively develop and prospectively validate a new, simple ECG-based algorithm considering the patients’ heart axis allowing for exact localization of APs in patients undergoing ablation for WPW. Methods and results Our multicentre study included 211 patients undergoing ablation of a single manifest AP due to WPW between 2013 and 2021. The algorithm was developed retrospectively and validated prospectively by comparing its efficacy to two established ones (Pambrun and Arruda). All patients (32 ± 19 years old, 47% female) underwent successful pathway ablation. Prediction of AP-localization was correct in 197 patients (93%) (sensitivity 92%, specificity 99%, PPV 96%, and NPV 99%). Our algorithm was particularly useful in correctly localizing antero-septal/-lateral (sensitivity and specificity 100%) and posteroseptal (sensitivity 98%, specificity 92%) AP in proximity to the tricuspid valve. The accuracy of EASY-WPW was superior compared to the Pambrun (93% vs. 84%, P = 0.003*) and the Arruda algorithm (94% vs. 75%, P < 0.001*). A subgroup analysis of children (n = 58, 12 ± 4 years old, 55% female) revealed superiority to the Arruda algorithm (P < 0.001*). The reproducibility of our algorithm was excellent (ϰ>0.8; P < 0.001*). Conclusion The novel EASY-WPW algorithm provides reliable and accurate pre-interventional ablation site determination in WPW patients. Only two steps are necessary to locate left-sided AP, and three steps to determine right-sided AP.

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“…In a comparison of 11 published algorithms in 266 adult patients (mostly with left-sided accessory pathways), Basiouny et al 14 found significantly worse performance for algorithms with more than six possible accessory pathway sites. They also found that the positive predictive value ranged from 86% for left lateral pathways to 45% for right anteroseptal pathways to 23% for right posterolateral pathways.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of algorithms to predict accessory pathway location in children with Wolff–Parkinson–White syndrome

Wren

Vogel

Lord

et al. 2011

Heart

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Accuracy and Limitations of Published Algorithms Using the Twelve‐Lead Electrocardiogram to Localize Overt Atrioventricular Accessory Pathways

Cited by 29 publications

References 36 publications

Accuracy of the Electrocardiogram in Localizing the Accessory Pathway in Patients with Wolff-Parkinson-White Pattern

Accuracy of the Electrocardiogram in Localizing the Accessory Pathway in Patients with Wolff-Parkinson-White Pattern

EASY-WPW: a novel ECG-algorithm for easy and reliable localization of manifest accessory pathways in children and adults

Accuracy of algorithms to predict accessory pathway location in children with Wolff–Parkinson–White syndrome

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