A Comparison of Twelve Algorithms for Diagnosing Accessory Pathway Location Applied in a Case Series of Patients With Wolff Parkinson White Syndrome

Wolff-Parkinson-White syndrome (WPW), a preexcitation condition characterized by the presence of an accessory pathway (bypass tract) between the atrium and ventricle.Researchers have developed several algorithms for localizing the accessory pathway based on 12 lead surface ECGs to date.We aim to compare twelve ECG algorithms,including two pediatric ones,using a case series of patients with WPW syndrome in this study.The government Chengalpattu Medical College hospital successfully treated five patients in this case series with radiofrequency ablation. We applied and compared twelve different algorithms (Milstein, 1987 [5], Fitzpatrick, 1994 [6], St.George, 1994 [7], Chiang, 1995 [8], D'avila,1995 [9],Arruda,1998 [10],Taguchi,2013 [11],Pambrun,2018 [12],Li H.Y.[13],Baek,2020 [14],Easy WPW,2023 [15], and EPM [16]), including two pediatric algorithms [13, 14]. Among the twelve algorithms, the D'avila, Taguchi, Pambrun, and Li H.Y. algorithms had the maximum diagnostic accuracy of 100%, followed by 80% with the easy WPW, Fitzpatrick, and EPM algorithms (Figure 1). In this case series, the Baek algorithm, which is a pediatric algorithm intended for diagnosing septal pathways,had the lowest accuracy.The other pediatric algorithm,developed by LiH.Y., demonstrated superior accuracy compared to the Baek algorithm.To conclude determining the exact pathway location prior to ablation leads to optimal procedure preparation, maps the pathways that are difficult to locate, and may also reduce catheter-related injury.In this case series,the algorithms designed by Taguchi,D'avila,Pambrun,and Li H.Y.had better predictions. Among the two pediatric algorithms, the algorithm by Li H.Y. had better accuracy than the Baek algorithm.