Asymptomatic ventricular pre-excitation in children

Abstract

According to our data, asymptomatic Wolff-Parkinson-White syndrome in children has a good outcome during a short-term (4 years) follow-up. The usefulness of electrophysiological evaluation (in particular its predictive value) is uncertain.

Risk Stratification in Wolff‐Parkinson‐White Syndrome: The Correlation Between Noninvasive and Invasive Testing in Pediatric Patients

“…The yield of any noninvasive testing to detect nonrapid AP conduction in our cohort was 18%, with 21% of patients who underwent EST demonstrating abrupt loss of preexcitation. These data are very similar to that found by Fazio et al 13 in a recent pediatric study of 124 patients, where 15% had intermittent preexcitation on Holter monitoring and 21% had abrupt disappearance of the delta wave with EST. As in our study, Fazio et al 13 also included no patients with sudden death or ventricular arrhythmias.…”

“…These data are very similar to that found by Fazio et al 13 in a recent pediatric study of 124 patients, where 15% had intermittent preexcitation on Holter monitoring and 21% had abrupt disappearance of the delta wave with EST. As in our study, Fazio et al 13 also included no patients with sudden death or ventricular arrhythmias. Similarly, Spar et al 27 reports 14% of pediatric WPW patients with abrupt loss of preexcitation and Czosek et al 8 report abrupt loss in 27% of their patients.…”

“…There are a number of papers in the literature on risk stratification for WPW 5–9 and whether or not to carry out transcatheter ablation for asymptomatic patients with this condition 8–12 . Noninvasive testing for risk assessment is commonly carried out as part of routine clinical practice and makes use of electrocardiograms (ECG), 24‐hour Holter monitors, and exercise stress tests (EST) 5,8,13 . Invasive testing during EPS uses atrial pacing and the induction of atrial fibrillation in order to determine the accessory pathway effective refractory period (APERP) as well as the shortest preexcited R‐R interval (SPRRI) during induced atrial fibrillation.…”

Utility of Exercise Testing and Adenosine Response for Risk Assessment in Children with Wolff-Parkinson-White Syndrome

“…In pediatric studies that started approximately three decades ago, it is stated that the sudden disappearance of delta‐waves during EST and normalization of QRS are associated with a long AERP‐AP (360–390 ms) . Studies that began in consequent years, which included a higher number of patients, showed that 14–27% of patients had a sudden disappearance of delta‐waves with EST, and that these patients were generally at low risk for sudden death . Similarly, in our study, 25% of the patients had a sudden disappearance of delta‐waves during the EST.…”

Intermittent versus Persistent Wolff‐Parkinson‐White Syndrome in Children: Electrophysiologic Properties and Clinical Outcomes

“…While this study employs a commonly used definition of a high‐risk pathway as having an APERP, BCL, or shortest preexcited RR interval in atrial fibrillation <250 ms, the overall rate of sudden death or other adverse clinical events has been very low in this study and the prior of intermittent WPW in children . No prior studies on the natural history of WPW in children have separated those with intermittency . Intermittent WPW is a relatively common clinical scenario for pediatric electrophysiologists, as the prevalence of intermittency in patients with WPW has ranged from 7% to as high as 50% in prior case series and meta‐analyses, so it will be important to continue to investigate long‐term outcomes in these patients in order to better weigh the risks and benefits of invasive testing and ablation.…”