Ventricular pre-excitation: symptomatic and asymptomatic children have the same potential risk of sudden cardiac death

Abstract

Children and adolescents with WPW syndrome have a higher rate of AVRT inducibility than asymptomatic patients. However, no differences between the two groups were found in atrial vulnerability and parameters related to the risk of SCD.

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia

“…60,[254][255][256][257] Notably, the absence of prior symptoms does not preclude risk because cardiac arrest may be the initial manifestation of pre-excitation. 254,257,411 Risk stratification, such as with ambulatory 24-hour monitoring or treadmill exercise testing, is often considered for children with pre-excitation to assess persistence of pre-excitation. 412 Pharmacological therapy of SVT in childhood is largely based on practice patterns because RCTs of antiarrhythmic medications in children are lacking.…”

Long-Term Natural History of Adult Wolff–Parkinson–White Syndrome Patients Treated With and Without Catheter Ablation

“…In pediatric patients, symptomatic and asymptomatic WPW patients have similar long-term sudden death risks. 11 In general, these data that suggest an overall low mortality rate and those from a meta-analysis of 10 studies of asymptomatic WPW patients do not support broad screening programs to reduce community cardiac arrest rates. 1 Recent studies have challenged the role of catheter ablation in WPW modulating the risk of AF particularly in adult patients.…”

Wolff–Parkinson–White syndrome (WPW) and athletes: Darwin at play?

“…There are also rare reports of patients with intermittent pre-excitation who have suffered ventricular fibrillation and cardiac arrest [19]. Thus the role of non-invasive testing remains of questionable benefit for risk assessing the young asymptomatic athlete with WPW and the use of an exercise test as a screening tool, we would argue, is not without significant limitations.…”

“…The 12-lead ECG and the rhythm strip pre-exercise demonstrate clear pre-excitation and the with exercise there is possible loss of pre-excitation, though baseline artifact and overall ECG quality limit the ability to conclude that there is abrupt and sudden loss of pre-excitation. pathway conduction who suffered syncope and VF arrest during exercise [18,19]. In these reports, while baseline invasive testing was reassuring, the addition of isoproterenol significantly enhanced AP conduction.…”