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Published on: February 22, 2018
New algorithm for accessory pathway localization focused on screening septal pathways in pediatric patients with
Seung Min Baek1, Mi Kyoung Song1, Jae-Sun Uhm2
1Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea.
Insights
Published algorithms for accessory pathway localization in Wolff-Parkinson-White syndrome are inaccurate in children. A new algorithm improves sensitivity for septal pathways in pediatric patients, addressing age-related electrocardiography trends.
Area of Science:
- Cardiology
- Pediatric Electrophysiology
Background:
- Published algorithms for accessory pathway localization in Wolff-Parkinson-White (WPW) syndrome demonstrate limited accuracy in pediatric patients, particularly for septal pathway identification.
- This inaccuracy is potentially linked to age-related trends in electrocardiography parameters observed in children.
Purpose of the Study:
- To develop and validate a novel algorithm for accessory pathway localization that enhances sensitivity for septal pathways in pediatric patients.
- To address the limitations of existing algorithms in the pediatric population.
Main Methods:
- A new algorithm was developed using electrocardiography parameters and accessory pathway locations from 120 pediatric WPW syndrome patients.
- The algorithm was validated in an additional 142 pediatric patients, with a total of 262 patients' electrocardiograms analyzed.
- Performance was compared against seven previously published algorithms.
Main Results:
- The new algorithm demonstrated superior sensitivity for septal pathways (95.7%) compared to published algorithms (average 62.1%), with a positive predictive value of 77.9%.
- Key parameters for the new algorithm include QRS polarity/shape for left/right discrimination and delta wave polarity/QRS transition/delta wave polarity for septal screening.
- Age-related trends in delta wave polarity and QRS axis were identified as contributing factors to the inaccuracy of older algorithms in children.
Conclusions:
- The developed algorithm is more accurate for localizing septal accessory pathways in pediatric patients with WPW syndrome.
- The findings highlight the importance of considering age-related electrocardiographic variations when localizing accessory pathways in children.
Background:
Published algorithms for accessory pathway localization in Wolff-Parkinson-White (WPW) syndrome are inaccurate in pediatric patients, especially for septal pathways.
Objective:
We aimed to develop a new algorithm that is sensitive for septal pathways and more applicable in pediatric patients.
Methods:
In 120 patients (mean age: 11.7 ± 3.9 years) who underwent catheter ablation for WPW syndrome, the candidate criteria for new algorithm were searched by comparing electrocardiography parameters and accessory pathway locations. A new algorithm was designed to increase the sensitivity for septal pathways. For validation, 142 patients (mean age: 15.8 ± 3.7 years) were additionally evaluated. New and published algorithms were applied to electrocardiography of 262 patients and the results were compared.
Results:
The new algorithm achieved its best discrimination by combining several parameters together in each step: (1) QRS polarity in V1 and QRS shape in lead I for left/right discrimination, and (2) delta wave polarity in V1, QRS transition in precordial leads, and delta wave polarity in lead III for septal pathway screening. The new algorithm showed higher sensitivity for septal pathways (95.7%) than 7 published algorithms (average: 62.1%), with satisfactory positive predictive value (77.9%). Delta wave polarity in V1 among septal pathways and QRS axis among right anteroseptal pathway showed age-related trend; this could be the reason for the lower accuracy in localizing septal pathways in children.
Conclusion:
The inaccuracy of published algorithms in pediatric patients is due to the age-related trend in the electrocardiography of septal pathways. The new algorithm was superior for localizing septal pathways in pediatric patients.
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