Journal Article Review Ahead of print
PubMed: 42578332 DOI: 10.1111/pace.70387
Diagnostic Accuracy of 12-Lead ECG Algorithms for Accessory Pathway Localization in WPW: A Meta-Analysis.
Pacing Clin Electrophysiol
Authors: Elsayed S Moubarak, Ahmed Farid Gadelmawla, Almothana Manasrah, Anas Mansour, Mohamed S Elgendy, Omar Elkoumi, Husam Abu Suilik, Suhaib El Khatib, Naser Albekaen, Ahmed Moustafa, Rania Samir, Islam Saboukh, Nadica Trajkovska, Angeliki Darma, Vanessa Sciacca, Thomas Fink, Moneeb Khalaph, Christian Sohns, Philipp Sommer, Hassan El-Shirbiny
Affiliations
- Faculty of Medicine, Cairo University, Cairo, Egypt.
- Faculty of Medicine, Menoufia University, Menoufia, Egypt.
- Department of Internal Medicine, United Health Services-Wilson Medical Center, Johnson City, New York, USA.
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
- Faculty of Medicine, Tanta University, Tanta, Egypt.
- Faculty of Medicine, Suez University, Suez, Egypt.
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan.
- Department of Internal Medicine, UCHealth Parkview Medical Center, Pueblo, Colorado, USA.
- Department of Internal Medicine, Prince Hamza Hospital, Amman, Jordan.
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
- Cardiology Department, Faculty of Medicine, Kafr Elsheikh University, Kafr El Sheikh, Egypt.
- Department of Electrophysiology, Heart and Diabetes Center NRW, Ruhr University Bochum, Bad Oeynhausen, Germany.
Abstract
BACKGROUND
In Wolff-Parkinson-White (WPW) syndrome, accurate localization of accessory pathways before catheter ablation can improve procedural planning and efficiency. Several 12-lead electrocardiographic (ECG) algorithms have been proposed, but their diagnostic performance has not been consistently established. We performed a systematic review and meta-analysis to assess the accuracy of ECG-based algorithms for accessory pathway localization in manifest WPW.
METHODS
Following PRISMA-DTA recommendations, PubMed, EMBASE, Cochrane CENTRAL, Web of Science, and Scopus were searched from January 1990 to January 2026. Studies enrolling adult or pediatric patients with manifest pre-excitation who underwent electrophysiological study (EPS) and catheter ablation were included. Successful localization during EPS/ablation served as the reference standard. Random-effects models were used to calculate pooled diagnostic accuracy, sensitivity, specificity, and diagnostic odds ratios (DOR). Summary receiver operating characteristic and leave-one-out sensitivity analyses were also performed.
RESULTS
Seventeen studies involving 3159 patients met inclusion criteria. The pooled diagnostic accuracy of ECG algorithms was 0.91 (95% CI 0.85-0.94), although heterogeneity was substantial (I 2 = 91.4%). Pooled sensitivity was 0.87 (95% CI 0.73-0.94), and pooled specificity was 0.98 (95% CI 0.95-0.99; I 2 = 0%). The pooled DOR was 297.17 (95% CI 46.33-1906.19; p<0.0001). Sensitivity analyses showed stable results after sequential exclusion of individual studies.
CONCLUSION
Twelve-lead ECG algorithms provide high diagnostic performance for accessory pathway localization in manifest WPW and may be useful adjuncts for pre-ablation planning, although invasive electrophysiological mapping remains essential.
MeSH
Arrhythmias, Cardiac, Algorithms, Catheter Ablation, Catheters