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From St George to EASY-WPW: Comparative Validation of Two ECG Algorithms for Accessory Pathway Localization
Session:
Sessão de Comunicações Orais 13 – Para além do isolamento das veias pulmonares: estratégias avançadas na ablação da fibrilhação auricular
Speaker:
Miguel Rocha
Congress:
CPC 2026
Topic:
C. Arrhythmias and Device Therapy
Theme:
06. Supraventricular Tachycardia (non-AF)
Subtheme:
06.3 Supraventricular Tachycardia (non-AF) - Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
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Authors:
Miguel Rocha; Helena Moreira; Pedro Palma; Joana Gonçalves; Emanuel Oliveira; Bernardo Cruz; Benedita Couto Viana; Erivaldo Figueiredo; Tiago Prata Branco; Luana Alves; Ana Isabel Pinho; Rui Simões Rodrigues
Abstract
<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>: Accurate localization of accessory pathways (APs) from baseline ECG is crucial for planning ablation in Wolff–Parkinson–White patients (WPW). The EASY-WPW algorithm, published in 2023, offers a simplified stepwise approach, but its performance relative to other classic AP location algorithms, such as the St. George’s algorithm, is yet to be extensively validated</span></span></p> <p><br /> <span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Aim</strong>: To compare the real-world diagnostic performance of EASY-WPW and the St George algorithm for AP localization, using electrophysiologic (EP) findings as the reference.</span></span><br /> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: We retrospectively analysed consecutive patients with WPW pattern who underwent successful AP ablation at a Portuguese tertiary centre between 2021–2024. Pre-excitation ECGs were independently classified using EASY-WPW and St George algorithms. AP location from EP study was coded into seven segments (right/left antero-, postero- and lateral). Exact seven-segment localization and grouped right/left and septal/free-wall categories were compared. Accuracy, segment-wise sensitivity and positive predictive value (PPV) were calculated. Paired accuracies were contrasted with McNemar tests, to assess for significant differences between algorithms in AP location.</span></span><br /> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: Of 154 eligible patients, 147 had complete ECG and EP data (mean age 33.1 ± 17.7 years; 71% male; 29% <18 years). EASY-WPW correctly identified the exact AP segment in 81/147 cases (55%), versus 54/147 (37%) with St George (McNemar p=0.001). Macro-averaged sensitivity and PPV across the seven locations were higher with EASY-WPW (53% and 52%) than with St George (39% and 36%). Right- versus left-sided classification was similar (73% vs 74%; p=0.86). However, EASY-WPW more accurately distinguished septal from free-wall pathways (80% vs 60%; p<0.001), with higher sensitivity for septal APs.</span></span><br /> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong>: In this cohort, EASY-WPW showed moderate but significantly better performance than the St George algorithm for detailed AP localization, while maintaining comparable side (right/left) determination and clearly superior septal/free-wall discrimination. Although its use should be exercised with caution, given its moderate accuracy, these findings provide external validation of EASY-WPW as a practical ECG tool for accessory pathway localization, including in mixed adult–paediatric populations and in settings with limited electrophysiology experience.</span></span></p>
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