{Reference Type}: Journal Article
{Title}: Can we improve the accuracy of electrocardiographic algorithms for accessory pathway location in children?
{Author}: Ferrari P;Malanchini G;Racheli M;Ferrari G;Leidi C;Senni M;Della Bella P;Malacrida M;Gulletta S;De Filippo P;
{Journal}: Kardiol Pol
{Volume}: 0
{Issue}: 0
{Year}: Dec 2021 2
{Factor}: 3.71
{DOI}: 10.33963/KP.a2021.0167
{Abstract}: <B>BACKGROUND: </B>Predicting accessory pathway location is extremely important in pediatric patients. We designed a study to compare previously published algorithms by Arruda, Boersma and Chiang.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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.