title: Automated detection of ventricular pre-excitation in pediatric 12-lead ECG.
abstract: BACKGROUND
  With increased interest in screening of young people for potential causes of sudden death, accurate automated detection of ventricular pre-excitation (VPE) or Wolff-Parkinson-White syndrome (WPW) in the pediatric resting ECG is important. Several recent studies have shown interobserver variability when reading screening ECGs and thus an accurate automated reading for this potential cause of sudden death is critical. We designed and tested an automated algorithm to detect pediatric VPE optimized for low prevalence.
  
  
  METHODS
  Digital ECGs with 12 leads or 15 leads (12-lead plus V3R, V4R and V7) were selected from multiple hospitals and separated into a testing and training database. Inclusion criterion was age less than 16 years. The reference for algorithm detection of VPE was cardiologist annotation of VPE for each ECG. The training database (n=772) consisted of VPE ECGs (n=37), normal ECGs (n=492) and a high concentration of conduction defects, RBBB (n=232) and LBBB (n=11). The testing database was a random sample (n=763). All ECGs were analyzed with the Philips DXL ECG Analysis algorithm for basic waveform measurements. Additional ECG features specific to VPE, mainly delta wave scoring, were calculated from the basic measurements and the average beat. A classifier based on decision tree bootstrap aggregation (tree bagger) was trained in multiple steps to select the number of decision trees and the 10 best features. The classifier accuracy was measured on the test database.
  
  
  RESULTS
  The new algorithm detected pediatric VPE with a sensitivity of 78%, a specificity of 99.9%, a positive predictive value of 88% and negative predictive value of 99.7%.
  
  
  CONCLUSIONS
  This new algorithm for detection of pediatric VPE performs well with a reasonable positive and negative predictive value despite the low prevalence in the general population.
authors: Advanced Algorithm Research Center, Philips Healthcare, Andover, MA, USA. Electronic address: rich.gregg@philips.com.
authors: Richard E
authors: RE
authors: Gregg
authors: Philips Research North America, Cambridge, MA, USA.
authors: Sophia H
authors: SH
authors: Zhou
authors: Division of Pediatric Cardiology, Stanford University, Palo Alto, CA, USA.
authors: Anne M
authors: AM
authors: Dubin
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010363:Pattern Recognition, Automated / Q000379:methods*; D011226:Pre-Excitation Syndromes / Q000175:diagnosis*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012984:Software
keywords: Automated 12-lead ECG analysis; Pediatric ECG; Ventricular pre-excitation; WPW