Bar-Cohen Yaniv, Khairy Paul, Morwood James, Alexander Mark E, Cecchin Frank, Berul Charles I
Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
J Cardiovasc Electrophysiol. 2006 Jul;17(7):712-6. doi: 10.1111/j.1540-8167.2006.00467.x.
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.
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).
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).
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.
用于定位预激综合征（WPW）患者旁路（AP）的心电图算法已在成人中得到验证，但在儿童中的应用情况知之甚少，尤其是在先天性心脏病（CHD）患者中。我们假设这些算法在儿童中的诊断准确性较低，而在患有CHD的儿童中更低。
对43例患有WPW和CHD的患者（中位年龄5.4岁[0.9 - 32岁]）的预激心电图进行评估，并与43例连续的无CHD的WPW对照患者（中位年龄14.5岁[1.8 - 18岁]）进行比较。两名盲法观察者使用2种成人和1种儿科WPW算法预测AP位置，第三名盲法观察者作为裁决者。将预测位置与经消融验证的AP位置进行比较，以确定（a）AP位置的精确匹配和（b）左右侧匹配（左侧与右侧AP）。
在对照儿童中，成人算法的准确率仅为56%和60%，而儿科算法的准确率为77%。在19例埃布斯坦畸形患者中，诊断准确性与对照组相似，有时预测左右侧的能力甚至更好。然而，在非埃布斯坦CHD患者中，这些算法明显更差（成人算法为29%，儿科算法为42%）。观察者间存在相对较大程度的变异性（kappa值为0.30至0.58）。
成人定位算法在患有和未患有CHD的年轻患者中诊断准确性较差。成人和儿科算法在非埃布斯坦CHD患者中都特别容易产生误导，应谨慎解读。
