Asymptomatic WPW Pattern Detected by School ECG Screening: Prevalence, Phenotype, and Automated Interpretation Errors

Area of Science:

• Pediatric Cardiology
• Electrophysiology
• Public Health Screening

Background:

• The Wolff-Parkinson-White (WPW) pattern involves ventricular preexcitation via accessory atrioventricular pathways.
• Limited population data exists on asymptomatic WPW pattern prevalence in children.
• Automated ECG interpretation can be unreliable in cases of preexcitation.

Purpose of the Study:

• To determine the prevalence of the WPW pattern in a large cohort of asymptomatic Romanian school children.
• To describe electrocardiographic characteristics and accessory pathway localization.
• To identify errors in automated ECG interpretation for WPW patterns.

Main Methods:

• Retrospective cross-sectional analysis of 24,112 ECGs from Romanian school children (ages 6-18).
• WPW pattern adjudicated by pediatric electrophysiologists.
• Prevalence calculated using the Wilson score method; sex differences assessed via Fisher's exact test.

Main Results:

• WPW pattern identified in 18 children, a prevalence of 0.075% (0.75 per 1000).
• A trend towards higher prevalence in boys (0.10%) versus girls (0.048%).
• Automated ECG interpretation errors included bundle branch block (27.8%) and pseudo-infarction (5.6%).

Conclusions:

• The WPW pattern prevalence in asymptomatic Romanian children is 0.074%, with a male predominance trend.
• Most identified WPW patterns showed mild preexcitation.
• Expert ECG review is crucial due to frequent misinterpretations by automated systems in pediatric screening.