Electrophysiologic Characteristics and Radiofrequency Catheter Ablation in Children with Wolff‐Parkinson‐White Syndrome

Lee, Pi Chang; Hwang, Betau; Chen, Yi Jen; Tai, Ching Tai; Chen, Shih Ann; Chiang, Chern En

doi:10.1111/j.1540-8159.2006.00381.x

Cited by 20 publications

(19 citation statements)

References 18 publications

(26 reference statements)

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“…Although a previous study examined sex differences in AP conduction properties by electrophysiology study, 12 none have identified AP location as a specific characteristic. One study involving only native Taiwanese patients described AP findings nearly identical to those observed in the Asians in our cohort: the right anterior position was found in 30% of patients and was the second most common location 8. To our knowledge, no previous study has specifically investigated the relationship between sex or race and AP location.…”

Section: Discussionsupporting

confidence: 78%

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Differences in accessory pathway location by sex and race

et al. 2010

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BACKGROUND The etiology of accessory pathway formation (AP) is generally unknown. OBJECTIVE Using sex and race as proxies to distinguish genetically different individuals, we sought to test the hypothesis that AP formation is genetically mediated by examining whether AP location differs by sex and/or race. METHODS This was a single center, retrospective cohort study of 282 consecutive patients undergoing their first electrophysiology study that revealed at least one AP between 2004–2008. Sex and race were compared to AP location determined by the invasive electrophysiology study. RESULTS Eighty-nine males (52%) and 40 (36%) females had a left posterior AP (p=0.006). Sixty-four females (57%) had a right annular AP compared to 55 (32%) males (p<0.001). After adjusting for age and race, females had a 2.8 fold greater odds of having a right annular AP compared to males (95% confidence interval [CI] 1.70–4.65 greater odds, p<0.001). While right anterior (free wall) pathways were rare in all other races (12%), a significantly larger proportion of Asians (n=10, 26%) had a right anterior AP (p=0.017). After adjusting for sex and age, Asians had a 3.8 fold greater odds of having a right anterior accessory pathway compared to other races (95% CI 1.5–9.4 greater odds, p=0.004). CONCLUSIONS Females more commonly had right annular APs, and Asians had right anterior APs substantially more frequently than other races. These findings suggest that the pathogenesis of AP formation may have a genetic component.

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Section: Discussionsupporting

confidence: 78%

“…However, a large proportion of the subjects involved in these studies were males and of the same race 6–8. Potential differences by sex and race have not previously been described.…”

Section: Introductionmentioning

confidence: 99%

Differences in accessory pathway location by sex and race

et al. 2010

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“…There are four type of re-entry: 1) Along anomalous pathways located around tricuspid or mitral annuli and directly connecting atrial to ventricular muscle [4,5].…”

Section: Introductionmentioning

confidence: 99%

Characterization of Supraventricular Tachycardia in Infants: Clinical and Instrumental Diagnosis

Vignati

Annoni

2008

CPD

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Supraventricular tachycardia (SVT) is the most common symptomatic arrhythmias in children. Re-entry tachycardias are the most common form, on the contrary automatic tachycardias are relatively rare. There are four types or re-entry: along anomalous pathway with bi-directional (Wolff-Parkinson-White) or unidirectional conduction, intranodal re-entry, intra-atrial re-entry that is common after surgical procedure, and finally the uncommon sinus node re-entry. Automatic tachycardias may be atrial or junctional. The different types of tachycardia have a different incidence according to the age: in the first year of age re-entry along anomalous pathway is the dominant form, while intranodal reentry becomes common during adolescence. The age at the beginning of tachycardia is important for long term prognosis. When SVT starts in the first months of life it disappears in 80% of cases within the first year of life; on the contrary, if tachycardia starts later spontaneous remission is detected in only 15%-20% of patients. In infancy heart failure is the more common presenting symptom, thereafter palpitations become the principal cause of recognition of SVT. Syncope is reported in about 8% of cases and in another 15% usually neonates and infants, the SVT has an occasional detection. Electrocardiogram (ecg) usually allows the precise diagnosis of various types of SVT, and every effort should be made to record ecg during tachycardia. The parameters that should be evaluated are: heart rate, P wave axis, PR and RP interval, and finally presence or absence of AV block. Short lasting episodes should be difficult to be recorded; in these cases cardio-call and trans-telephonic transmission represent useful techniques to obtain SVT demonstration. Patients with SVT require a complete evaluation with others diagnostic techniques: echocardiogram, Holter monitoring, stress test, that should be chosen according the type of tachycardia. Electrophysiologic evaluation is now rarely performed for diagnostic purpose; trans-esophageal atrial stimulation being less invasive than intracardiac evaluation is more extensively employed when diagnosis of SVT is uncertain. Transesophageal stimulation is useful in the following situations: 1) evaluation of patients with symptoms suggestive of paroxistic tachycardia but without ecg documentation, 2) to assess the mechanism responsible for re-entry tachycardia: macro re-entry versus intranodal re-entry 3) to evaluate characteristics of anomalous pathway with bi-directional conduction, and 4)to terminate re-entrant SVT.

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“…46 Results are similar in pediatric studies, with ablation success rates of 92% to 100% and recurrence rates of 0% to 13%. 6,13,26,29,44,47 …”

Section: Managementmentioning

confidence: 99%

Evaluation and Management of Wolff-Parkinson-White in Athletes

et al. 2013

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Context:Wolff-Parkinson-White (WPW) is a cardiac conduction system disorder characterized by abnormal accessory conduction pathways between the atria and the ventricles. Symptomatic patients classically present with palpitations, presyncope, or syncope that results from supraventricular tachycardia. While rare, sudden cardiac death may be the first manifestation of underlying disease and occurs more frequently in exercising individuals.Evidence Acquisition:Medline and PubMed databases were evaluated through 2012, with the following keywords: WPW, Wolff-Parkinson-White, pre-excitation, sudden cardiac death, risk stratification, and athletes. Selected articles identified through the primary search, along with relevant references from those articles, were reviewed for pertinent clinical information regarding the identification, evaluation, risk stratification, and management of WPW as they pertained to the care of athletes.Study Design:Systematic review.Level of Evidence:Level 1.Results:Diagnosis of WPW is confirmed by characteristic electrocardiogram changes, which include a delta wave, short PR interval, and widened QRS complex. Utilization of the electrocardiogram as part of the preparticipation physical evaluation may allow for early identification of asymptomatic individuals with a WPW pattern. Risk stratification techniques identify individuals at risk for malignant arrhythmias who may be candidates for curative therapy through transcatheter ablation.Conclusion:WPW accounts for at least 1% of sudden death in athletes and has a prevalence of at least 1 to 4.5 per 1000 children and adults. The risk of lethal arrhythmia appears to be higher in asymptomatic children than in adults, and sudden cardiac death is often the sentinel event. The athlete with WPW should be evaluated for symptoms and the presence of intermittent or persistent pre-excitation, which dictates further consultation, treatment, and monitoring strategies as well as return to play.

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Electrophysiologic Characteristics and Radiofrequency Catheter Ablation in Children with Wolff‐Parkinson‐White Syndrome

Abstract: This study demonstrated the difference in the electrophysiologic characteristics of APs and the AV node between pediatric and adult patients. RF catheter ablation was a safe and effective method to manage children with WPW syndrome.

Cited by 20 publications

References 18 publications

Differences in accessory pathway location by sex and race

Differences in accessory pathway location by sex and race

Characterization of Supraventricular Tachycardia in Infants: Clinical and Instrumental Diagnosis

Evaluation and Management of Wolff-Parkinson-White in Athletes

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