Assessment of the physical performance in children with asymptomatic pre-excitation

Abstract

Aims Pre-excitation syndrome can lead to recurrent supraventricular tachycardias (SVTs) and carries a risk of sudden cardiac death (SCD). However, an underestimated consequence of antegrade conduction through an accessory pathway is fusion of intrinsic and accessory conduction that causes asynchronous activation and myocardial contraction that could be a cause for cardiac dysfunction and dilation. It is not known to what extent pre-excitation affects myocardial and physical performance in those patients. The aim of the study was to assess to what degree ventricular pre-excitation affects physical performance in children, using cardio-pulmonary exercise testing (CPET). Methods and results The study group consisted of 30 asymptomatic children, aged 8–17 years, with pre-excitation and no history or documentation of SVT compared to 31 healthy controls matched according to sex and age. All patients underwent routine cardiology assessment and then CPET. Echocardiography showed there were no differences in the left ventricular size and function between the study and control group. During the CPET both, patients and controls achieved maximal effort. Patients in the study group showed significantly lower values of VO2max and anaerobic threshold when compared to controls. The most affected subgroup was patients with persistent pre-excitation throughout the exercise. Conclusions Physical performance is affected in children with pre-excitation. This effect is stronger in patients with persistent delta wave observed throughout the exercise.

Radiofrequency catheter ablation for improving myocardial work in patients with ventricular pre-excitation

“…Cases of improvement of exercise intolerance after RFCA in patients with ventricular pre-excitation have also been reported (27)(28)(29). Using cardiopulmonary exercise testing, Książczyk et al (30) demonstrated impaired physical performance in asymptomatic children with ventricular preexcitation compared to matched healthy children (VO 2 max: 36.67±6.66 vs. 44.45±8.37 mL/kg/min; P<0.001). Their follow-up study identified improvement in the physical performance in children with ventricular pre-excitation (31).…”

Wolf–Parkinson–White Syndrome: Diagnosis, Risk Assessment, and Therapy—An Update

“…It may vary from no symptoms at all to slight thoracic pressure or palpitations, or even syncope or sudden cardiac death as the first symptom. Currently, the idea of asymptomatic overt pre-excitation is challenged, as even in children, its presence is associated with reduced exercise capacity (due to APs-induced asynchrony and LV dysfunction) [49]. This might explain the increased risk for heart failure in adults with overt pre-excitation [50].…”

Advancing the science of management of arrhythmic disease in children and adult congenital heart disease patients within the last 25 years

“…In a compelling 2022 Europace article, Ksiazczyk et al . 56 identified that physical performance as measured by cardiopulmonary exercise testing (CPET) was worse in children with WPW even in the absence of symptoms or tachycardia. They found that key CPET parameters of physical performance were affected by pre-excitation.…”