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Peer-reviewedCC BY 4.0Pacing and Clinical Electrophysiology

Diagnostic Accuracy of 12‐Lead ECG Algorithms for Accessory Pathway Localization in WPW: A Meta‐Analysis

  • Elsayed S. Moubarak1
  • Ahmed Farid Gadelmawla2
  • Almothana Manasrah3
  • Anas Mansour4
  • Mohamed S. Elgendy5
  • Omar Elkoumi6
  • Husam Abu Suilik7
  • Suhaib El Khatib8
  • Naser Albekaen9
  • Ahmed Moustafa1
  • Rania Samir10
  • Islam Saboukh11
8 more authors
  • Nadica Trajkovska12
  • Angeliki Darma12
  • Vanessa Sciacca12
  • Thomas Fink12
  • Moneeb Khalaph12
  • Christian Sohns12
  • Philipp Sommer12
  • Hassan El‐Shirbiny11,12
12 affiliations
  1. 1Faculty of Medicine Cairo University Cairo Egypt
  2. 2Faculty of Medicine Menoufia University Menoufia Egypt
  3. 3Department of Internal Medicine United Health Services—Wilson Medical Center Johnson City New York USA
  4. 4Faculty of Medicine Al‐Azhar University Cairo Egypt
  5. 5Faculty of Medicine Tanta University Tanta Egypt
  6. 6Faculty of Medicine Suez University Suez Egypt
  7. 7Faculty of Medicine The Hashemite University Zarqa Jordan
  8. 8Department of Internal Medicine UCHealth Parkview Medical Center Pueblo Colorado USA
  9. 9Department of Internal Medicine Prince Hamza Hospital Amman Jordan
  10. 10Department of Cardiology, Faculty of Medicine Ain Shams University Cairo Egypt
  11. 11Cardiology Department, Faculty of Medicine Kafr Elsheikh University Kafr El Sheikh Egypt
  12. 12Department of Electrophysiology, Heart and Diabetes Center NRW, Ruhr University Bochum Bad Oeynhausen Germany
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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 (I2 = 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; I2 = 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.

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Cite

BibTeXRIS
BibTeX
@article{moubarak2026diagnostic,
  title = {{Diagnostic Accuracy of 12‐Lead ECG Algorithms for Accessory Pathway Localization in WPW: A Meta‐Analysis}},
  author = {Elsayed S. Moubarak and Ahmed Farid Gadelmawla and Almothana Manasrah and Anas Mansour and Mohamed S. Elgendy and Omar Elkoumi and Husam Abu Suilik and Suhaib El Khatib and Naser Albekaen and Ahmed Moustafa and Rania Samir and Islam Saboukh and Nadica Trajkovska and Angeliki Darma and Vanessa Sciacca and Thomas Fink and Moneeb Khalaph and Christian Sohns and Philipp Sommer and Hassan El‐Shirbiny},
  journal = {Pacing and Clinical Electrophysiology},
  year = {2026},
  month = aug,
  doi = {10.1111/pace.70387},
  url = {https://doi.org/10.1111/pace.70387},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Diagnostic Accuracy of 12‐Lead ECG Algorithms for Accessory Pathway Localization in WPW: A Meta‐Analysis
AU  - Elsayed S. Moubarak
AU  - Ahmed Farid Gadelmawla
AU  - Almothana Manasrah
AU  - Anas Mansour
AU  - Mohamed S. Elgendy
AU  - Omar Elkoumi
AU  - Husam Abu Suilik
AU  - Suhaib El Khatib
AU  - Naser Albekaen
AU  - Ahmed Moustafa
AU  - Rania Samir
AU  - Islam Saboukh
AU  - Nadica Trajkovska
AU  - Angeliki Darma
AU  - Vanessa Sciacca
AU  - Thomas Fink
AU  - Moneeb Khalaph
AU  - Christian Sohns
AU  - Philipp Sommer
AU  - Hassan El‐Shirbiny
PY  - 2026
DA  - 2026/08/11
JO  - Pacing and Clinical Electrophysiology
DO  - 10.1111/pace.70387
UR  - https://doi.org/10.1111/pace.70387
AB  - 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 (I2 = 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; I2 = 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.
SN  - 0147-8389
SN  - 1540-8159
ER  -