Inaccuracy of Wolff‐Parkinson‐White Accessory Pathway Localization Algorithms in Children and Patients with Congenital Heart Defects
Identifieur interne : 001280 ( Main/Exploration ); précédent : 001279; suivant : 001281Inaccuracy of Wolff‐Parkinson‐White Accessory Pathway Localization Algorithms in Children and Patients with Congenital Heart Defects
Auteurs : Yaniv Bar-Cohen [États-Unis] ; Paul Khairy [États-Unis] ; James Morwood [États-Unis] ; Mark E. Alexander [États-Unis] ; Frank Cecchin [États-Unis] ; Charles I. Berul [États-Unis]Source :
- Journal of Cardiovascular Electrophysiology [ 1045-3873 ] ; 2006-07.
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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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Alexander</name></author><author><name sortKey="Cecchin, Frank" sort="Cecchin, Frank" uniqKey="Cecchin F" first="Frank" last="Cecchin">Frank Cecchin</name></author><author><name sortKey="Berul, Charles I" sort="Berul, Charles I" uniqKey="Berul C" first="Charles I." last="Berul">Charles I. Berul</name></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><idno type="wicri:Area/Main/Curation">000668</idno><idno type="wicri:Area/Main/Exploration">001280</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 wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Khairy, Paul" sort="Khairy, Paul" uniqKey="Khairy P" first="Paul" last="Khairy">Paul Khairy</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Morwood, James" sort="Morwood, James" uniqKey="Morwood J" first="James" last="Morwood">James Morwood</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></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 wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Cecchin, Frank" sort="Cecchin, Frank" uniqKey="Cecchin F" first="Frank" last="Cecchin">Frank Cecchin</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></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 wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; and the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></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><affiliations><list><country><li>États-Unis</li></country><region><li>Massachusetts</li></region></list><tree><country name="États-Unis"><region name="Massachusetts"><name sortKey="Bar Ohen, Yaniv" sort="Bar Ohen, Yaniv" uniqKey="Bar Ohen Y" first="Yaniv" last="Bar-Cohen">Yaniv Bar-Cohen</name></region><name sortKey="Alexander, Mark E" sort="Alexander, Mark E" uniqKey="Alexander M" first="Mark E." last="Alexander">Mark E. Alexander</name><name sortKey="Berul, Charles I" sort="Berul, Charles I" uniqKey="Berul C" first="Charles I." last="Berul">Charles I. Berul</name><name sortKey="Cecchin, Frank" sort="Cecchin, Frank" uniqKey="Cecchin F" first="Frank" last="Cecchin">Frank Cecchin</name><name sortKey="Khairy, Paul" sort="Khairy, Paul" uniqKey="Khairy P" first="Paul" last="Khairy">Paul Khairy</name><name sortKey="Morwood, James" sort="Morwood, James" uniqKey="Morwood J" first="James" last="Morwood">James Morwood</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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