Management of Asymptomatic Wolff–Parkinson–White Pattern in Young Patients: Has Anything Changed?

Raposo, Daniela Marcos; António, Natália; Andrade, Helena; Sousa, Pedro; Pires, António; Gonçalves, Lino

doi:10.1007/s00246-019-02110-6

Cited by 7 publications

(4 citation statements)

References 19 publications

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“…The 33 patients who met inclusion criteria for an antegrade-only accessory pathway are the subjects of this analysis. The median patient age at time of the electrophysiology study was 14 [10][11][12][13][14][15][16] years and 16 (48%) were male (Table 1). The most common presenting symptoms were palpitations (47%), chest pain (25%), and syncope (22%).…”

Section: Resultsmentioning

confidence: 99%

“…This remains a debated issue, despite several guidelines and surveys regarding catheter ablation in the asymptomatic patient with ventricular pre-excitation. 5,12,13 Furthermore, determination of the antegrade effective refractory period of an antegrade-only accessory pathway in the setting of a second antegrade accessory pathway may be imprecise. The findings of a differential effective refractory period with programmed stimulation with a change in the pattern of pre-excitation was observed in three of the four cases with multiple antegrade accessory pathways and has been reported to be a useful finding to suggest the presence of multiple accessory pathways.…”

Section: Discussionmentioning

confidence: 99%

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Characteristics of antegrade-only accessory pathways in children and adolescents

et al. 2021

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There is minimal data regarding antegrade-only accessory pathways in young patients. Given evolving recommendations and treatments, retrospective analysis of the clinical and electrophysiologic properties of antegrade-only pathways in patients <21 years old was performed, with subsequent comparison of electrophysiology properties to age-matched controls with bidirectional pathways. Of 522 consecutive young patients with ventricular pre-excitation referred for electrophysiology study, 33 (6.3%) had antegrade-only accessory pathways. Indications included palpitations (47%), chest pain (25%), and syncope (22%). The shortest value for either the accessory pathway effective refractory period or the pre-excited R-R interval was taken for each patient, with the median of the antegrade-only group significantly greater than shortest values for the bidirectional group (310 [280–360] ms versus 270 [240–302] ms, p < 0.001). However, the prevalence of pathways with high-risk properties (effective refractory period or shortest pre-excited R-R interval <250 ms) was similar in both study patients and controls (13% versus 21%) (p = 0.55). Sixteen patients had a single antegrade-only accessory pathway and no inducible arrhythmia. Six patients had Mahaim fibres, all right anterolateral with inducible antidromic reciprocating tachycardia. However, 11 patients with antegrade-only accessory pathways and 3 with Mahaim fibres had inducible tachycardia due to a second substrate recognised at electrophysiology study. These included concealed accessory pathways (7), bidirectional accessory pathways (5), and atrioventricular node re-entry (2). Antegrade-only accessory pathways require comprehensive electrophysiology evaluation as confounding factors such as high-risk conduction properties or inducible Supraventricular Tachycardia (SVT) due to a second substrate of tachycardia are often present.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Characteristics of antegrade-only accessory pathways in children and adolescents

et al. 2021

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“…14 Current guidelines recommend catheter ablation for class IIB patients at age > 5 years and class III patients at age < 5 years. 15 As our WPW patients had intermittent preexcitation on Holter recording and were class IIB, they were given only antiarrhythmic drug treatment. As follow-ups of the patients were consistent with the literature, our study suggests that current guidelines for arrhythmias be useful and no different approach be needed for patients who have WPW or PVC observed in routine EEG-ECG recordings.…”

Section: Discussionmentioning

confidence: 99%

Routine Interictal EEG Recording Should be Performed Together with Simultaneous Two-Lead ECG Recording

Yılmaz

Işıkay

Yavuz

et al. 2022

Journal of Pediatric Epilepsy

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We aimed to evaluate the contribution of simultaneous electrocardiography (ECG) recording during routine interictal electroencephalography (EEG) recording in patients with seizures or epilepsy and therefore to provide evidence-based data on this subject. Patients with interictal cardiac arrhythmia on routine EEG-ECG recordings were determined and evaluated based on cardiologic and neurologic findings. Out of 1,078 patients aged between 5 and 16 years (mean: 10.2 ± 3.2), 9 (0.08%) patients were found to have an arrhythmia. Six patients had both epilepsy and cardiac arrhythmia (premature ventricular contractions [PVCs] in 5; Wolff-Parkinson-White [WPW] in 1 patient) and the remaining three patients had nonepileptic paroxysmal events (NPEs) and arrhythmia (PVC in 2; WPW in 1). Three patients had other diseases (neurofibromatosis type 1, tuberous sclerosis, and congenital heart disease status postsurgery). Cardiac arrhythmia required radiofrequency ablation or antiarrhythmic drug treatment in two patients with epilepsy and also two patients with NPE; however, it improved with no specific treatment in the remaining five patients. NPE was not related to arrhythmia in one of three patients with NPE. Our study suggests that routine interictal EEG-ECG recording provides a valuable and feasible opportunity to reveal unnoticed or new-onset cardiac arrhythmias. Therefore, ECG should be recorded simultaneously during routine interictal EEG recordings. Cardiac arrhythmias detected by routine interictal EEG-ECG recordings would require arrhythmia treatment in nearly half of the patients.

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“…Although SCD/SCA used to be considered exceptionally rare in asymptomatic subjects [80], more recent multicenter data showed that, albeit small, the risk of SCD/SCA is significantly and unacceptably higher [48], particularly in children, in whom it can be between 0.7% [5] up to 2% for a mean follow-up of 8 years [81]. Although EPT is an imperfect tool, its negative predictive value is considered very good in asymptomatic subjects, especially if performed with catecholamine [71] infusion and without general anesthesia [82].…”

Section: Invasive Assessmentmentioning

confidence: 99%

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

Vătășescu,

Paja,

Șuș

et al. 2024

Diagnostics

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Wolf–Parkinson–White (WPW) syndrome is a disorder characterized by the presence of at least one accessory pathway (AP) that can predispose people to atrial/ventricular tachyarrhythmias and even sudden cardiac death. It is the second most common cause of paroxysmal supraventricular tachycardia in most parts of the world, affecting about 0.1–0.3% of the general population. Most patients with WPW syndrome have normal anatomy, but it may be associated with concomitant congenital heart disease or systemic diseases. Although many individuals are asymptomatic, during supraventricular arrhythmia episodes, they may experience severe symptoms, including syncope or even sudden cardiac death (mainly due to pre-excited atrial fibrillation over rapidly conducting AP). In addition to arrhythmia-related symptoms, for some specific locations of the APs with overt anterograde conduction, there might be a reduction in exercise capacity mediated by a reduction in LV systolic performance due to anomalous LV depolarization. Although it is typically diagnosed through electrocardiography (ECG), additional tests are necessary for risk assessment. Management of WPW syndrome may be quite challenging and can vary from only acknowledging the presence of the accessory pathway to pharmacological treatment or radiofrequency ablation. Early diagnosis, risk assessment, and appropriate treatment are critical steps in the management of WPW syndrome, aiming to improve the quality of life and reduce the risk of life-threatening arrhythmias.

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Management of Asymptomatic Wolff–Parkinson–White Pattern in Young Patients: Has Anything Changed?

Cited by 7 publications

References 19 publications

Characteristics of antegrade-only accessory pathways in children and adolescents

Characteristics of antegrade-only accessory pathways in children and adolescents

Routine Interictal EEG Recording Should be Performed Together with Simultaneous Two-Lead ECG Recording

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

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