Validación de algoritmo Arruda, Iturralde, Milstein en el electrocardiograma para la localización del haz accesorio en Wolff Parkinson White
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2021
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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Antecedentes. El síndrome de Wolff Parkinson White (WPW) es una anomalía cardiaca congénita que afecta a un 0,1-3 % de la población general, la presentación clínica más habitual son episodios paroxísticos de palpitaciones, de carácter benigno, aunque en estos pacientes la probabilidad de muerte súbita es superior a la población general. Se diagnostica de síndrome WPW a aquellos pacientes con preexcitación en el electrocardiograma e historia clínica de palpitaciones, taquicardia o síncope de origen arritmogénico. Objetivo general: El objetivo de este estudio fue evidenciar el algoritmo con mayor suficiencia diagnóstica en el electrocardiograma para la localización del haz accesorio en los pacientes con síndrome de Wolf Parkinson White. Materiales y Métodos. El diseño fue descriptivo, retro-prospectivo, de corte transversal, basado en el análisis de los parámetros electrocardiográficos de WPW, el uso secuencial de algoritmos electrocardiográficos y la ubicación de la VA en el EEF. Se compararon los tres algoritmos más utilizados para evaluar la capacidad diagnóstica en la localización de la vía accesoria con relación al resultado del estudio electrofisiológico. La correlación entre cada algoritmo y el resultado del EEF fue analizada mediante correlación de Pearson, la capacidad diagnóstica ha sido calculada mediante Curva ROC (0,5 – 1) y la fiabilidad de cada prueba medido con el coeficiente alfa de Cronbach (0,70 a 0,90). Resultados: Se recuperó 31 pacientes, con una mediana de edad de 38 años, de los cuales el 51.6% correspondió al género masculino. Mediante estudio electrofisiológico, se identificó las vías accesorias más frecuentes como lateral izquierda 36%, posterolateral izquierda 19%. El área bajo la curva del algoritmo de Iturralde de 0,900; de Arruda 0,600 y de Milstein 0,933 con IC 95%. Existiendo diferencia estadísticamente significativa (P=0.047) entre tales resultados. Se evidencia correlación positiva alta y moderada para los algoritmos de Milstein e Iturralde (r = 0,720; r = 0,392) y correlación negativa baja para el algoritmo de Arruda (r = -0,155). El coeficiente alfa de Cronbach calculado en 0,89, 0,78 y 0,30 para Milstein, Iturralde y Arruda respectivamente. Conclusiones: Los algoritmos de Iturralde y Milstein constituyen una herramienta útil y sencilla con capacidad diagnóstica que le permite al cardiólogo clínico y al electrofisiólogo la adecuada toma de decisiones dada su sensibilidad, especificidad y correlación positiva en la detección de la vía accesoria previo estudio electrofisiológico y así planificar un estudio con menor probabilidad de complicaciones y ahorro de recursos.
Background. Wolff Parkinson White syndrome (WPW) is a congenital heart anomaly that affects 0.1-3% of the general population; the most common clinical presentation is paroxysmal episodes of palpitations, of a benign nature, although in these patients the probability of sudden death is higher than the general population. Patients with pre-excitation on the electrocardiogram and a clinical history of palpitations, tachycardia or syncope of arrhythmogenic origin are diagnosed with WPW syndrome. General objective. The objective of this study was to demonstrate the algorithm with the greatest diagnostic sufficiency in the electrocardiogram for the localization of the accessory bundle in patients with Wolf Parkinson White syndrome. Materials and methods. The design was descriptive, retro-prospective, cross-sectional, based on the analysis of the electrocardiographic parameters of the WPW, the sequential use of electrocardiographic algorithms, and the location of the VA in the EPS. The three most used algorithms to evaluate the diagnostic capacity in the location of the accessory pathway were compared in relation to the result of the electrophysiological study. The correlation between each algorithm and the SEE result was analyzed using Pearson's correlation, the diagnostic capacity was calculated using the ROC curve (0.5 - 1) and the reliability of each test measured with the Cronbach's alpha coefficient (0.70 at 0.90). Results: 31 patients were recovered, with a median age of 38 years, of which 51.6% corresponded to the male gender. By electrophysiological study, the most frequent accessory pathways were identified as 36% left lateral, 19% left posterolateral. The area under the curve of the Iturralde algorithm of 0.900; Arruda 0.600 and Milstein 0.933 with 95% CI. There is a statistically significant difference (P = 0.047) between these results. There is a high and moderate positive correlation for the Milstein and Iturralde algorithms (r = 0.720; r = 0.392) and a low negative correlation for the Arruda algorithm (r = -0.155). Cronbach's alpha coefficient calculated at 0.89, 0.78 and 0.30 for Milstein, Iturralde and Arruda respectively. Conclusions: The Iturralde and Milstein algorithms constitute a useful and simple tool with diagnostic capacity that allows the clinical cardiologist and the electrophysiologist to make adequate decisions given its sensitivity, specificity and positive correlation in the detection of the pathway. accessory after an electrophysiological study and thus plan a study with a lower probability of complications and saving resources.
Background. Wolff Parkinson White syndrome (WPW) is a congenital heart anomaly that affects 0.1-3% of the general population; the most common clinical presentation is paroxysmal episodes of palpitations, of a benign nature, although in these patients the probability of sudden death is higher than the general population. Patients with pre-excitation on the electrocardiogram and a clinical history of palpitations, tachycardia or syncope of arrhythmogenic origin are diagnosed with WPW syndrome. General objective. The objective of this study was to demonstrate the algorithm with the greatest diagnostic sufficiency in the electrocardiogram for the localization of the accessory bundle in patients with Wolf Parkinson White syndrome. Materials and methods. The design was descriptive, retro-prospective, cross-sectional, based on the analysis of the electrocardiographic parameters of the WPW, the sequential use of electrocardiographic algorithms, and the location of the VA in the EPS. The three most used algorithms to evaluate the diagnostic capacity in the location of the accessory pathway were compared in relation to the result of the electrophysiological study. The correlation between each algorithm and the SEE result was analyzed using Pearson's correlation, the diagnostic capacity was calculated using the ROC curve (0.5 - 1) and the reliability of each test measured with the Cronbach's alpha coefficient (0.70 at 0.90). Results: 31 patients were recovered, with a median age of 38 years, of which 51.6% corresponded to the male gender. By electrophysiological study, the most frequent accessory pathways were identified as 36% left lateral, 19% left posterolateral. The area under the curve of the Iturralde algorithm of 0.900; Arruda 0.600 and Milstein 0.933 with 95% CI. There is a statistically significant difference (P = 0.047) between these results. There is a high and moderate positive correlation for the Milstein and Iturralde algorithms (r = 0.720; r = 0.392) and a low negative correlation for the Arruda algorithm (r = -0.155). Cronbach's alpha coefficient calculated at 0.89, 0.78 and 0.30 for Milstein, Iturralde and Arruda respectively. Conclusions: The Iturralde and Milstein algorithms constitute a useful and simple tool with diagnostic capacity that allows the clinical cardiologist and the electrophysiologist to make adequate decisions given its sensitivity, specificity and positive correlation in the detection of the pathway. accessory after an electrophysiological study and thus plan a study with a lower probability of complications and saving resources.
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ARRITMIAS CARDIACAS, SINDROME DE WILFF-PARKINSON-WHITE, ABLACION DE CATETER, ELECTROCARDIOGRAFIA, ALGORITMO DE DIAGNOSTICO, EPIDEMIOLOGIA DESCRIPTIVA, ESTUDIOS RETROSPECTIVOS, HOSPITAL DE ESPECIALIDADES GUAYAQUIL DR. ABEL GILBERT PONTON, CANTON GUAYAQUIL, ECUADOR