Inaccuracy of Wolff‐Parkinson‐White Accessory Pathway Localization Algorithms in Children and Patients with Congenital Heart Defects
Identifieur interne : 000766 ( Main/Corpus ); précédent : 000765; suivant : 000767Inaccuracy of Wolff‐Parkinson‐White Accessory Pathway Localization Algorithms in Children and Patients with Congenital Heart Defects
Auteurs : Yaniv Bar-Cohen ; Paul Khairy ; James Morwood ; Mark E. Alexander ; Frank Cecchin ; Charles I. BerulSource :
- Journal of Cardiovascular Electrophysiology [ 1045-3873 ] ; 2006-07.
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- KwdEn :
Abstract
Introduction: ECG algorithms used to localize accessory pathways (AP) in patients with Wolff‐Parkinson‐White (WPW) syndrome have been validated in adults, but less is known of their use in children, especially in patients with congenital heart disease (CHD). We hypothesize that these algorithms have low diagnostic accuracy in children and even lower in those with CHD. Methods: Pre‐excited ECGs in 43 patients with WPW and CHD (median age 5.4 years [0.9–32 years]) were evaluated and compared to 43 consecutive WPW control patients without CHD (median age 14.5 years [1.8–18 years]). Two blinded observers predicted AP location using 2 adult and 1 pediatric WPW algorithms, and a third blinded observer served as a tiebreaker. Predicted locations were compared with ablation‐verified AP location to identify (a) exact match for AP location and (b) match for laterality (left‐sided vs right‐sided AP). Results: In control children, adult algorithms were accurate in only 56% and 60%, while the pediatric algorithm was correct in 77%. In 19 patients with Ebstein's anomaly, diagnostic accuracy was similar to controls with at times an even better ability to predict laterality. In non‐Ebstein's CHD, however, the algorithms were markedly worse (29% for the adult algorithms and 42% for the pediatric algorithms). A relatively large degree of interobserver variability was seen (kappa values from 0.30 to 0.58). Conclusions: Adult localization algorithms have poor diagnostic accuracy in young patients with and without CHD. Both adult and pediatric algorithms are particularly misleading in non‐Ebstein's CHD patients and should be interpreted with caution.
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DOI: 10.1111/j.1540-8167.2006.00467.x
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Inaccuracy of Wolff‐Parkinson‐White Accessory Pathway Localization Algorithms in Children and Patients with Congenital Heart Defects</title><author><name sortKey="Bar Ohen, Yaniv" sort="Bar Ohen, Yaniv" uniqKey="Bar Ohen Y" first="Yaniv" last="Bar-Cohen">Yaniv Bar-Cohen</name><affiliation><mods:affiliation>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</mods:affiliation></affiliation></author><author><name sortKey="Khairy, Paul" sort="Khairy, Paul" uniqKey="Khairy P" first="Paul" last="Khairy">Paul Khairy</name><affiliation><mods:affiliation>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</mods:affiliation></affiliation></author><author><name sortKey="Morwood, James" sort="Morwood, James" uniqKey="Morwood J" first="James" last="Morwood">James Morwood</name><affiliation><mods:affiliation>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</mods:affiliation></affiliation></author><author><name sortKey="Alexander, Mark E" sort="Alexander, Mark E" uniqKey="Alexander M" first="Mark E." last="Alexander">Mark E. Alexander</name><affiliation><mods:affiliation>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</mods:affiliation></affiliation></author><author><name sortKey="Cecchin, Frank" sort="Cecchin, Frank" uniqKey="Cecchin F" first="Frank" last="Cecchin">Frank Cecchin</name><affiliation><mods:affiliation>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</mods:affiliation></affiliation></author><author><name sortKey="Berul, Charles I" sort="Berul, Charles I" uniqKey="Berul C" first="Charles I." last="Berul">Charles I. Berul</name><affiliation><mods:affiliation>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:9502BDD0B5F83418B9857F2228D6B86D09AE5DC2</idno><date when="2006" year="2006">2006</date><idno type="doi">10.1111/j.1540-8167.2006.00467.x</idno><idno type="url">https://api.istex.fr/document/9502BDD0B5F83418B9857F2228D6B86D09AE5DC2/fulltext/pdf</idno><idno type="wicri:Area/Main/Corpus">000766</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Inaccuracy of Wolff‐Parkinson‐White Accessory Pathway Localization Algorithms in Children and Patients with Congenital Heart Defects</title><author><name sortKey="Bar Ohen, Yaniv" sort="Bar Ohen, Yaniv" uniqKey="Bar Ohen Y" first="Yaniv" last="Bar-Cohen">Yaniv Bar-Cohen</name><affiliation><mods:affiliation>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</mods:affiliation></affiliation></author><author><name sortKey="Khairy, Paul" sort="Khairy, Paul" uniqKey="Khairy P" first="Paul" last="Khairy">Paul Khairy</name><affiliation><mods:affiliation>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</mods:affiliation></affiliation></author><author><name sortKey="Morwood, James" sort="Morwood, James" uniqKey="Morwood J" first="James" last="Morwood">James Morwood</name><affiliation><mods:affiliation>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</mods:affiliation></affiliation></author><author><name sortKey="Alexander, Mark E" sort="Alexander, Mark E" uniqKey="Alexander M" first="Mark E." last="Alexander">Mark E. Alexander</name><affiliation><mods:affiliation>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</mods:affiliation></affiliation></author><author><name sortKey="Cecchin, Frank" sort="Cecchin, Frank" uniqKey="Cecchin F" first="Frank" last="Cecchin">Frank Cecchin</name><affiliation><mods:affiliation>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</mods:affiliation></affiliation></author><author><name sortKey="Berul, Charles I" sort="Berul, Charles I" uniqKey="Berul C" first="Charles I." last="Berul">Charles I. Berul</name><affiliation><mods:affiliation>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of Cardiovascular Electrophysiology</title><idno type="ISSN">1045-3873</idno><idno type="eISSN">1540-8167</idno><imprint><publisher>Blackwell Publishing Inc</publisher><pubPlace>Malden, USA</pubPlace><date type="published" when="2006-07">2006-07</date><biblScope unit="volume">17</biblScope><biblScope unit="issue">7</biblScope><biblScope unit="page" from="712">712</biblScope><biblScope unit="page" to="716">716</biblScope></imprint><idno type="ISSN">1045-3873</idno></series><idno type="istex">9502BDD0B5F83418B9857F2228D6B86D09AE5DC2</idno><idno type="DOI">10.1111/j.1540-8167.2006.00467.x</idno><idno type="ArticleID">JCE467</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1045-3873</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Wolff‐Parkinson‐White syndrome</term><term>accessory pathway</term><term>catheter ablation</term><term>electrocardiogram</term><term>pediatrics</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Introduction: ECG algorithms used to localize accessory pathways (AP) in patients with Wolff‐Parkinson‐White (WPW) syndrome have been validated in adults, but less is known of their use in children, especially in patients with congenital heart disease (CHD). We hypothesize that these algorithms have low diagnostic accuracy in children and even lower in those with CHD. Methods: Pre‐excited ECGs in 43 patients with WPW and CHD (median age 5.4 years [0.9–32 years]) were evaluated and compared to 43 consecutive WPW control patients without CHD (median age 14.5 years [1.8–18 years]). Two blinded observers predicted AP location using 2 adult and 1 pediatric WPW algorithms, and a third blinded observer served as a tiebreaker. Predicted locations were compared with ablation‐verified AP location to identify (a) exact match for AP location and (b) match for laterality (left‐sided vs right‐sided AP). Results: In control children, adult algorithms were accurate in only 56% and 60%, while the pediatric algorithm was correct in 77%. In 19 patients with Ebstein's anomaly, diagnostic accuracy was similar to controls with at times an even better ability to predict laterality. In non‐Ebstein's CHD, however, the algorithms were markedly worse (29% for the adult algorithms and 42% for the pediatric algorithms). A relatively large degree of interobserver variability was seen (kappa values from 0.30 to 0.58). Conclusions: Adult localization algorithms have poor diagnostic accuracy in young patients with and without CHD. Both adult and pediatric algorithms are particularly misleading in non‐Ebstein's CHD patients and should be interpreted with caution.</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>YANIV BAR‐COHEN M.D.</name><affiliations><json:string>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</json:string></affiliations></json:item><json:item><name>PAUL KHAIRY M.D., Ph.D.</name><affiliations><json:string>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</json:string></affiliations></json:item><json:item><name>JAMES MORWOOD M.B.B.S.</name><affiliations><json:string>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</json:string></affiliations></json:item><json:item><name>MARK E. ALEXANDER M.D.</name><affiliations><json:string>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</json:string></affiliations></json:item><json:item><name>FRANK CECCHIN M.D.</name><affiliations><json:string>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</json:string></affiliations></json:item><json:item><name>CHARLES I. BERUL M.D.</name><affiliations><json:string>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Wolff‐Parkinson‐White syndrome</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>accessory pathway</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>electrocardiogram</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>catheter ablation</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>pediatrics</value></json:item></subject><articleId><json:string>JCE467</json:string></articleId><language><json:string>eng</json:string></language><abstract>Introduction: ECG algorithms used to localize accessory pathways (AP) in patients with Wolff‐Parkinson‐White (WPW) syndrome have been validated in adults, but less is known of their use in children, especially in patients with congenital heart disease (CHD). We hypothesize that these algorithms have low diagnostic accuracy in children and even lower in those with CHD. Methods: Pre‐excited ECGs in 43 patients with WPW and CHD (median age 5.4 years [0.9–32 years]) were evaluated and compared to 43 consecutive WPW control patients without CHD (median age 14.5 years [1.8–18 years]). Two blinded observers predicted AP location using 2 adult and 1 pediatric WPW algorithms, and a third blinded observer served as a tiebreaker. Predicted locations were compared with ablation‐verified AP location to identify (a) exact match for AP location and (b) match for laterality (left‐sided vs right‐sided AP). Results: In control children, adult algorithms were accurate in only 56% and 60%, while the pediatric algorithm was correct in 77%. In 19 patients with Ebstein's anomaly, diagnostic accuracy was similar to controls with at times an even better ability to predict laterality. In non‐Ebstein's CHD, however, the algorithms were markedly worse (29% for the adult algorithms and 42% for the pediatric algorithms). A relatively large degree of interobserver variability was seen (kappa values from 0.30 to 0.58). Conclusions: Adult localization algorithms have poor diagnostic accuracy in young patients with and without CHD. Both adult and pediatric algorithms are particularly misleading in non‐Ebstein's CHD patients and should be interpreted with caution.</abstract><qualityIndicators><score>6.113</score><pdfVersion>1.3</pdfVersion><pdfPageSize>594.006 x 783.008 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>5</keywordCount><abstractCharCount>1657</abstractCharCount><pdfWordCount>3137</pdfWordCount><pdfCharCount>20741</pdfCharCount><pdfPageCount>5</pdfPageCount><abstractWordCount>248</abstractWordCount></qualityIndicators><title>Inaccuracy of Wolff‐Parkinson‐White Accessory Pathway Localization Algorithms in Children and Patients with Congenital Heart Defects</title><genre><json:string>article</json:string></genre><host><volume>17</volume><publisherId><json:string>JCE</json:string></publisherId><pages><total>5</total><last>716</last><first>712</first></pages><issn><json:string>1045-3873</json:string></issn><issue>7</issue><genre><json:string>Journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1540-8167</json:string></eissn><title>Journal of Cardiovascular Electrophysiology</title><doi><json:string>10.1111/(ISSN)1540-8167</json:string></doi></host><publicationDate>2006</publicationDate><copyrightDate>2006</copyrightDate><doi><json:string>10.1111/j.1540-8167.2006.00467.x</json:string></doi><id>9502BDD0B5F83418B9857F2228D6B86D09AE5DC2</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/9502BDD0B5F83418B9857F2228D6B86D09AE5DC2/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/9502BDD0B5F83418B9857F2228D6B86D09AE5DC2/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/9502BDD0B5F83418B9857F2228D6B86D09AE5DC2/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Inaccuracy of Wolff‐Parkinson‐White Accessory Pathway Localization Algorithms in Children and Patients with Congenital Heart Defects</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Blackwell Publishing Inc</publisher><pubPlace>Malden, USA</pubPlace><availability><p>WILEY</p></availability><date>2006</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Inaccuracy of Wolff‐Parkinson‐White Accessory Pathway Localization Algorithms in Children and Patients with Congenital Heart Defects</title><author><persName><forename type="first">YANIV</forename><surname>BAR‐COHEN</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</affiliation></author><author><persName><forename type="first">PAUL</forename><surname>KHAIRY</surname></persName><roleName type="degree">M.D., Ph.D.</roleName><affiliation>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</affiliation></author><author><persName><forename type="first">JAMES</forename><surname>MORWOOD</surname></persName><roleName type="degree">M.B.B.S.</roleName><affiliation>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</affiliation></author><author><persName><forename type="first">MARK E.</forename><surname>ALEXANDER</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</affiliation></author><author><persName><forename type="first">FRANK</forename><surname>CECCHIN</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</affiliation></author><author><persName><forename type="first">CHARLES I.</forename><surname>BERUL</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</affiliation></author></analytic><monogr><title level="j">Journal of Cardiovascular Electrophysiology</title><idno type="pISSN">1045-3873</idno><idno type="eISSN">1540-8167</idno><idno type="DOI">10.1111/(ISSN)1540-8167</idno><imprint><publisher>Blackwell Publishing Inc</publisher><pubPlace>Malden, USA</pubPlace><date type="published" when="2006-07"></date><biblScope unit="volume">17</biblScope><biblScope unit="issue">7</biblScope><biblScope unit="page" from="712">712</biblScope><biblScope unit="page" to="716">716</biblScope></imprint></monogr><idno type="istex">9502BDD0B5F83418B9857F2228D6B86D09AE5DC2</idno><idno type="DOI">10.1111/j.1540-8167.2006.00467.x</idno><idno type="ArticleID">JCE467</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2006</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Introduction: ECG algorithms used to localize accessory pathways (AP) in patients with Wolff‐Parkinson‐White (WPW) syndrome have been validated in adults, but less is known of their use in children, especially in patients with congenital heart disease (CHD). We hypothesize that these algorithms have low diagnostic accuracy in children and even lower in those with CHD. Methods: Pre‐excited ECGs in 43 patients with WPW and CHD (median age 5.4 years [0.9–32 years]) were evaluated and compared to 43 consecutive WPW control patients without CHD (median age 14.5 years [1.8–18 years]). Two blinded observers predicted AP location using 2 adult and 1 pediatric WPW algorithms, and a third blinded observer served as a tiebreaker. Predicted locations were compared with ablation‐verified AP location to identify (a) exact match for AP location and (b) match for laterality (left‐sided vs right‐sided AP). Results: In control children, adult algorithms were accurate in only 56% and 60%, while the pediatric algorithm was correct in 77%. In 19 patients with Ebstein's anomaly, diagnostic accuracy was similar to controls with at times an even better ability to predict laterality. In non‐Ebstein's CHD, however, the algorithms were markedly worse (29% for the adult algorithms and 42% for the pediatric algorithms). A relatively large degree of interobserver variability was seen (kappa values from 0.30 to 0.58). Conclusions: Adult localization algorithms have poor diagnostic accuracy in young patients with and without CHD. Both adult and pediatric algorithms are particularly misleading in non‐Ebstein's CHD patients and should be interpreted with caution.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>Wolff‐Parkinson‐White syndrome</term></item><item><term>accessory pathway</term></item><item><term>electrocardiogram</term></item><item><term>catheter ablation</term></item><item><term>pediatrics</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2006-07">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/9502BDD0B5F83418B9857F2228D6B86D09AE5DC2/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Blackwell Publishing Inc</publisherName><publisherLoc>Malden, USA</publisherLoc></publisherInfo><doi origin="wiley" registered="yes">10.1111/(ISSN)1540-8167</doi><issn type="print">1045-3873</issn><issn type="electronic">1540-8167</issn><idGroup><id type="product" value="JCE"></id><id type="publisherDivision" value="ST"></id></idGroup><titleGroup><title type="main" sort="JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY">Journal of Cardiovascular Electrophysiology</title></titleGroup></publicationMeta><publicationMeta level="part" position="07007"><doi origin="wiley">10.1111/jce.2006.17.issue-7</doi><numberingGroup><numbering type="journalVolume" number="17">17</numbering><numbering type="journalIssue" number="7">7</numbering></numberingGroup><coverDate startDate="2006-07">July 2006</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="4" status="forIssue"><doi origin="wiley">10.1111/j.1540-8167.2006.00467.x</doi><idGroup><id type="unit" value="JCE467"></id></idGroup><countGroup><count type="pageTotal" number="5"></count></countGroup><titleGroup><title type="tocHeading1">ORIGINAL ARTICLES</title><title type="tocHeading2"><i>Clinical</i></title></titleGroup><eventGroup><event type="firstOnline" date="2006-03-23"></event><event type="publishedOnlineFinalForm" date="2006-03-23"></event><event type="xmlConverted" agent="Converter:BPG_TO_WML3G version:2.3.5 mode:FullText source:FullText result:FullText" date="2010-04-07"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-01-29"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-10-23"></event></eventGroup><numberingGroup><numbering type="pageFirst" number="712">712</numbering><numbering type="pageLast" number="716">716</numbering></numberingGroup><correspondenceTo>Address for correspondence: Charles I. Berul, M.D., Department of Cardiology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115. Fax: (617) 566‐5671; E‐mail: <email>charles.berul@cardio.chboston.org</email></correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:JCE.JCE467.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="0"></count><count type="tableTotal" number="4"></count><count type="formulaTotal" number="0"></count><count type="referenceTotal" number="11"></count><count type="linksCrossRef" number="18"></count></countGroup><titleGroup><title type="main">Inaccuracy of Wolff‐Parkinson‐White Accessory Pathway Localization Algorithms in Children and Patients with Congenital Heart Defects</title></titleGroup><creators><creator creatorRole="author" xml:id="cr1" affiliationRef="#a1"><personName><givenNames>YANIV</givenNames><familyName>BAR‐COHEN</familyName><degrees>M.D.</degrees></personName></creator><creator creatorRole="author" xml:id="cr2" affiliationRef="#a1"><personName><givenNames>PAUL</givenNames><familyName>KHAIRY</familyName><degrees>M.D., Ph.D.</degrees></personName></creator><creator creatorRole="author" xml:id="cr3" affiliationRef="#a1"><personName><givenNames>JAMES</givenNames><familyName>MORWOOD</familyName><degrees>M.B.B.S.</degrees></personName></creator><creator creatorRole="author" xml:id="cr4" affiliationRef="#a1"><personName><givenNames>MARK E.</givenNames><familyName>ALEXANDER</familyName><degrees>M.D.</degrees></personName></creator><creator creatorRole="author" xml:id="cr5" affiliationRef="#a1"><personName><givenNames>FRANK</givenNames><familyName>CECCHIN</familyName><degrees>M.D.</degrees></personName></creator><creator creatorRole="author" xml:id="cr6" affiliationRef="#a1"><personName><givenNames>CHARLES I.</givenNames><familyName>BERUL</familyName><degrees>M.D.</degrees></personName></creator></creators><affiliationGroup><affiliation xml:id="a1" countryCode="US"><unparsedAffiliation>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en"><keyword xml:id="k1"><i>Wolff‐Parkinson‐White syndrome</i></keyword><keyword xml:id="k2"><i>accessory pathway</i></keyword><keyword xml:id="k3"><i>electrocardiogram</i></keyword><keyword xml:id="k4"><i>catheter ablation</i></keyword><keyword xml:id="k5"><i>pediatrics</i></keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><!-- Wolff-Parkinson-White syndrome. 
<p> <i>Introduction:</i> ECG algorithms used to localize accessory pathways (AP) in patients with Wolff‐Parkinson‐White (WPW) syndrome have been validated in adults, but less is known of their use in children, especially in patients with congenital heart disease (CHD). We hypothesize that these algorithms have low diagnostic accuracy in children and even lower in those with CHD.</p><p> <i>Methods:</i> Pre‐excited ECGs in 43 patients with WPW and CHD (median age 5.4 years [0.9–32 years]) were evaluated and compared to 43 consecutive WPW control patients without CHD (median age 14.5 years [1.8–18 years]). Two blinded observers predicted AP location using 2 adult and 1 pediatric WPW algorithms, and a third blinded observer served as a tiebreaker. Predicted locations were compared with ablation‐verified AP location to identify (a) exact match for AP location and (b) match for laterality (left‐sided vs right‐sided AP).</p><p> <i>Results:</i> In control children, adult algorithms were accurate in only 56% and 60%, while the pediatric algorithm was correct in 77%. In 19 patients with Ebstein's anomaly, diagnostic accuracy was similar to controls with at times an even better ability to predict laterality. In non‐Ebstein's CHD, however, the algorithms were markedly worse (29% for the adult algorithms and 42% for the pediatric algorithms). A relatively large degree of interobserver variability was seen (kappa values from 0.30 to 0.58).</p><p> <i>Conclusions:</i> Adult localization algorithms have poor diagnostic accuracy in young patients with and without CHD. Both adult and pediatric algorithms are particularly misleading in non‐Ebstein's CHD patients and should be interpreted with caution.</p><!-- (J Cardiovasc Electrophysiol, Vol. 17, pp. 712-716, July 2006)
</abstractGroup></contentMeta><noteGroup><note xml:id="n-fnt-1" numbered="no"><p>Paul Khairy holds a Canada Research chair. He received funding for this study from an Electrophysiology and Adult Congenital Heart Disease and Research Scholarship and the Canadian Institutes of Health Research.</p></note><note xml:id="n-fnt-2" numbered="no"><p>Manuscript received 12 December 2005; Revised manuscript received 20 January 2006; Accepted for publication 24 January 2006.</p></note></noteGroup></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Inaccuracy of Wolff‐Parkinson‐White Accessory Pathway Localization Algorithms in Children and Patients with Congenital Heart Defects</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Inaccuracy of Wolff‐Parkinson‐White Accessory Pathway Localization Algorithms in Children and Patients with Congenital Heart Defects</title></titleInfo><name type="personal"><namePart type="given">YANIV</namePart><namePart type="family">BAR‐COHEN</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">PAUL</namePart><namePart type="family">KHAIRY</namePart><namePart type="termsOfAddress">M.D., Ph.D.</namePart><affiliation>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">JAMES</namePart><namePart type="family">MORWOOD</namePart><namePart type="termsOfAddress">M.B.B.S.</namePart><affiliation>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">MARK E.</namePart><namePart type="family">ALEXANDER</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">FRANK</namePart><namePart type="family">CECCHIN</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">CHARLES I.</namePart><namePart type="family">BERUL</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Blackwell Publishing Inc</publisher><place><placeTerm type="text">Malden, USA</placeTerm></place><dateIssued encoding="w3cdtf">2006-07</dateIssued><copyrightDate encoding="w3cdtf">2006</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="tables">4</extent><extent unit="references">11</extent></physicalDescription><abstract lang="en">Introduction: ECG algorithms used to localize accessory pathways (AP) in patients with Wolff‐Parkinson‐White (WPW) syndrome have been validated in adults, but less is known of their use in children, especially in patients with congenital heart disease (CHD). We hypothesize that these algorithms have low diagnostic accuracy in children and even lower in those with CHD. Methods: Pre‐excited ECGs in 43 patients with WPW and CHD (median age 5.4 years [0.9–32 years]) were evaluated and compared to 43 consecutive WPW control patients without CHD (median age 14.5 years [1.8–18 years]). Two blinded observers predicted AP location using 2 adult and 1 pediatric WPW algorithms, and a third blinded observer served as a tiebreaker. Predicted locations were compared with ablation‐verified AP location to identify (a) exact match for AP location and (b) match for laterality (left‐sided vs right‐sided AP). Results: In control children, adult algorithms were accurate in only 56% and 60%, while the pediatric algorithm was correct in 77%. In 19 patients with Ebstein's anomaly, diagnostic accuracy was similar to controls with at times an even better ability to predict laterality. In non‐Ebstein's CHD, however, the algorithms were markedly worse (29% for the adult algorithms and 42% for the pediatric algorithms). A relatively large degree of interobserver variability was seen (kappa values from 0.30 to 0.58). Conclusions: Adult localization algorithms have poor diagnostic accuracy in young patients with and without CHD. Both adult and pediatric algorithms are particularly misleading in non‐Ebstein's CHD patients and should be interpreted with caution.</abstract><subject lang="en"><genre>Keywords</genre><topic>Wolff‐Parkinson‐White syndrome</topic><topic>accessory pathway</topic><topic>electrocardiogram</topic><topic>catheter ablation</topic><topic>pediatrics</topic></subject><relatedItem type="host"><titleInfo><title>Journal of Cardiovascular Electrophysiology</title></titleInfo><genre type="Journal">journal</genre><identifier type="ISSN">1045-3873</identifier><identifier type="eISSN">1540-8167</identifier><identifier type="DOI">10.1111/(ISSN)1540-8167</identifier><identifier type="PublisherID">JCE</identifier><part><date>2006</date><detail type="volume"><caption>vol.</caption><number>17</number></detail><detail type="issue"><caption>no.</caption><number>7</number></detail><extent unit="pages"><start>712</start><end>716</end><total>5</total></extent></part></relatedItem><identifier type="istex">9502BDD0B5F83418B9857F2228D6B86D09AE5DC2</identifier><identifier type="DOI">10.1111/j.1540-8167.2006.00467.x</identifier><identifier type="ArticleID">JCE467</identifier><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>Blackwell Publishing Inc</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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