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Ferrari P, Malanchini G, Racheli M, et al. Can we improve the accuracy of electrocardiographic algorithms for accessory pathway location in children?. Kardiol Pol. 2021;doi: 10.33963/KP.a2021.0167.
Ferrari, P., Malanchini, G., Racheli, M., Ferrari, G., Leidi, C., Senni, M., Della Bella, P., Malacrida, M., Gulletta, S., & De Filippo, P. (2021). Can we improve the accuracy of electrocardiographic algorithms for accessory pathway location in children?. Kardiologia polska, . https://doi.org/10.33963/KP.a2021.0167
Ferrari, Paola, et al. "Can we improve the accuracy of electrocardiographic algorithms for accessory pathway location in children?." Kardiologia polska vol. (2021). doi: https://doi.org/10.33963/KP.a2021.0167
Ferrari P, Malanchini G, Racheli M, Ferrari G, Leidi C, Senni M, Della Bella P, Malacrida M, Gulletta S, De Filippo P. Can we improve the accuracy of electrocardiographic algorithms for accessory pathway location in children?. Kardiol Pol. 2021 Dec 02; doi: 10.33963/KP.a2021.0167. Epub 2021 Dec 02. PMID: 34856632.
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Kardiol Pol. 2021 Dec 02; doi: 10.33963/KP.a2021.0167. Epub 2021 Dec 02.

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

Kardiologia polska

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

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.

PMID: 34856632 DOI: 10.33963/KP.a2021.0167

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.

Keywords: WPW; algorithm; children; pediatric; pre-excitation

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