Use of electrophysiologic testing to assess risk in children with Wolff-Parkinson-White syndrome

Abstract

In adults with Wolff-Parkinson-White syndrome, the likelihood of sudden death can be estimated based upon the presence or absence of symptoms. Comparable data in children do not exist. To date, therefore, invasive risk stratification has been used to guide management regarding radiofrequency ablation in symptomatic children. As the safety of electrophysiology study and radiofrequency ablation in children has improved, asymptomatic patients have been referred more commonly for invasive risk stratification. We sought to compare the findings from electrophysiologic studies in symptomatic children with Wolff-Parkinson-White syndrome to the findings in asymptomatic children with Wolff-Parkinson-White pattern on their electrocardiogram. Thus, we compared the findings from electrophysiologic studies carried out in patients seen at Stanford University and University of California, San Francisco, from April 1999 to February 2001 with a preexcitation pattern on their electrocardiogram. The patients were divided into three groups: 23 asymptomatic patients studied for risk stratification, 19 patients who presented with syncope, and 77 patients presenting with documented supraventricular tachycardia. Data were collected for commonly accepted invasive criterions for stratification of risk: an effective refractory period of the accessory pathway less than 270 ms, multiple pathways, septal location of pathway, and inducibility of supraventricular tachycardia. Groups were compared by chi-square. No differences were found between the groups for any of the variables. These data suggest that risk factors for sudden death, developed in studies of adult patients, are not clearly applicable to children. Further studies are needed better to define the indications for study and ablation in children.

Isoproterenol Administration During General Anesthesia for the Evaluation of Children With Ventricular Preexcitation

“…19,20 It is likely, however, that such generalizations cannot be applied to the pediatric population, in whom a risk for future cardiac events exists even when asymptomatic. 1-2 Like Dubin et al, 9 who noted that the electrophysiologic profiles of symptomatic versus asymptomatic children with ventricular preexcitation are not significantly different, we also found no difference in accessorypathway conduction characteristics across patient groups. We made an effort to subclassify patients into syncopal groups of varying etiology (neurocardiogenic vs arrhythmic) to detect differences in accessory-pathway conduction that might exist within these cohorts.…”

“…The study of the isoproterenol effect on pathway conduction in children has been limited 8,9 and warrants additional scrutiny in light of recent published reports. An explanation for the increased incidence of potentially life-threatening arrhythmias in children may relate to inherently short accessory-pathway characteristics at baseline, an exaggerated response of the accessory pathway to adrenergic stimuli, or both.…”

Electrophysiologic Profile and Results of Invasive Risk Stratification in Asymptomatic Children and Adolescents With the Wolff–Parkinson–White Electrocardiographic Pattern

“…8 Although noninvasive diagnostic methods such as 24-hour Holter monitoring and exercise stress testing are useful for basic assessment of the preexcitation, invasive testing should be considered to define electrophysiological properties of the AP in case of antegrade AP conduction persistence through maximum exercise. 5,[9][10][11][12] Persistent preexcitation during exercise has high sensitivity and high negative predictive value for detection of patients at risk. 13 However, patients with clear and abrupt loss of preexcitation during exercise testing are at low risk of sudden cardiac death.…”

Survey of Current Practice of Pediatric Electrophysiologists for Asymptomatic Wolff-Parkinson-White Syndrome

“…The absence of life-threatening symptoms did not necessarily connote low risk. Finally, Dubin et al 10 recently assessed 100 pediatric patients who had WPW syndrome and underwent electrophysiologic evaluation for risk stratification, documented SVT, or syncope. Asymptomatic patients had statistically the same recognized EPS risk profile as the symptomatic patients.…”