Accurate estimation of accessory pathway (AP) localization in patients with ventricular pre-excitation or Wolff-Parkinson-White (WPW) syndrome remains a diagnostic challenge. Existing algorithms have contributed significantly to this area, but alternative algorithms can offer additional perspectives and approaches to AP localization. This study introduces and evaluates the diagnostic accuracy of the EPM algorithm in AP localization, comparing it with established algorithms Arruda and EASY. A retrospective analysis was conducted on 138 patients from Hospital São Paulo who underwent catheter ablation. Three blinded examiners assessed the EPM algorithm's diagnostic accuracy against the Arruda and EASY algorithms. The gold standard for comparison was the radioscopic position of the AP where radiofrequency ablation led to pre-excitation disappearance on the ECG. EPM showed a diagnostic accuracy of 51.45%, closely aligning with Arruda (53.29%) and EASY (44.69%). Adjacency accuracy for EPM was 70.67%, with Arruda at 66.18% and EASY at 72.22%. Sensitivity for EPM in distinguishing left vs. right APs was 95.73%, with a specificity of 74.33%. For identifying septal vs. lateral right APs, EPM sensitivity was 82.79% with a specificity of 46.15%. These measures were comparable to those of Arruda and EASY. Inter-observer variability was excellent for EPM, with Kappa statistics over 0.9. The EPM algorithm emerges as a reliable tool for AP localization, offering a systematic approach beneficial for therapeutic decision-making in electrophysiology. Its comparable diagnostic accuracy and excellent inter-observer variability underscore its potential clinical applicability. Future research may further validate its efficacy in a broader clinical setting.

中文翻译：

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EPM 算法：心室预激旁路定位的逐步方法

准确估计心室预激或沃尔夫-帕金森-怀特 (WPW) 综合征患者的旁路 (AP) 定位仍然是一个诊断挑战。现有算法对此领域做出了重大贡献，但替代算法可以为 AP 定位提供额外的视角和方法。本研究介绍并评估了 EPM 算法在 AP 定位中的诊断准确性，并将其与现有算法 Arruda 和 EASY 进行了比较。对圣保罗医院 138 名接受导管消融术的患者进行了回顾性分析。三名盲法检查员根据 Arruda 和 EASY 算法评估了 EPM 算法的诊断准确性。比较的金标准是射频消融导致心电图上预激消失的 AP 的放射镜位置。EPM 显示诊断准确率为 51.45%，与 Arruda (53.29%) 和 EASY (44.69%) 非常接近。EPM 的邻接准确率为 70.67%，Arruda 为 66.18%，EASY 为 72.22%。EPM 区分左右 AP 的敏感性为 95.73%，特异性为 74.33%。对于识别间隔与右外侧 AP，EPM 敏感性为 82.79%，特异性为 46.15%。这些措施与 Arruda 和 EASY 的措施相当。EPM 的观察者间变异性非常好，Kappa 统计数据超过 0.9。EPM 算法成为 AP 定位的可靠工具，提供了有利于电生理学治疗决策的系统方法。其可比的诊断准确性和出色的观察者间变异性强调了其潜在的临床适用性。未来的研究可能会在更广泛的临床环境中进一步验证其功效。