Wolff-Parkinson-White syndrome in infants and children. A long-term follow-up study.

Giardina, Andrea; Ehlers, Kathryn H.; Engle, Mary Allen

doi:10.1136/hrt.34.8.839

Cited by 113 publications

(29 citation statements)

References 22 publications

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“…Interestingly, despite the perception that medical management of supraventricular tachycardia in infants is benign, mortality rates of Ϸ5% have been reported in infants with Wolff-Parkinson-White syndrome and supraventricular tachycardia who were treated medically. 22,23 Furthermore, no comparable mortality data exist for medical management of only those infants who have life-threatening arrhythmias or a group with congenital heart disease.…”

Section: Complicationsmentioning

confidence: 99%

Radiofrequency Catheter Ablation in Infants ≤18 Months Old

Blaufox

Felix²,

Saul³

2001

Circulation

111

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Participating Members of the Pediatric Catheter Ablation Registry* Background-The objective of this study was to determine the indications, the safety, and the efficacy of pediatric radiofrequency catheter ablation (RFCA) in infants. Methods and Results-Data from the pediatric RFCA registry were reviewed. Between August 1989 and January 1999, 137 infants, defined by age 0 to 1.5 years (median 0.7 years; weight 1.9 to 14.8 kg, median 10 kg), underwent 152 procedures in 27 of 49 registry centers (55%), compared with 5960 noninfants undergoing 6610 procedures during a comparable period. Structural heart disease was present in 36% of infants, compared with 11.2% of noninfants (PϽ0.0001). RFCA in infants was performed more commonly for drug resistance or life-threatening arrhythmias than in noninfants. No differences were found between infants and noninfants in success for all tachycardia substrates (87.6% versus 90.6%, Pϭ0.11), for single accessory pathways (94.5% versus 91.5%, Pϭ0.4), or for total (7.8% versus 7.4%, Pϭ1) and major (4.6% versus 2.9%, Pϭ0.17) complications. Neither success for infants with a single accessory pathway nor complications for the entire infant group were related to weight, age, center size, or the presence of structural heart disease. Centers that performed infant procedures, however, enrolled more patients overall in the registry than those that did not perform infant procedures, and successful procedures in infants were performed by more experienced physicians than failed procedures. Conclusions-Compared with noninfants, RFCA in infants is usually performed for drug resistance or life-threatening arrhythmias, often in the presence of structural heart disease. The data support the use of RFCA by experienced physicians in selected infants. (Circulation. 2001;104:2803-2808.)

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Section: Complicationsmentioning

confidence: 99%

Radiofrequency Catheter Ablation in Infants ≤18 Months Old

Blaufox

Felix²,

Saul³

2001

Circulation

111

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“…A unique and rare feature of this case was the recent onset of syncope attacks associated with this tachycardia, evolving at a fairly advanced age of 72 years old, without previous documentation of WPW syndrome in ECG. The prevalence of tachyarrhythmias has been reported to decrease with age in WPW syndrome (9,12,13). Although its mechanism is uncertain, some degenerative changes of the accessory pathways developing with age and ensuring prolongation of the ERP have been proposed (10,14,15).…”

Section: Discussionmentioning

confidence: 99%

Late Onset of Wolff-Parkinson-White Syndrome in a 72-year-old Man

et al. 2004

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We encountered a case of wide QRS tachycardia with chronic atrial fibrillation in Wolff-Parkinson-White syndrome. Unique features were late onset of syncope attacks associated with this tachycardia at an advanced age of 72 years old without previous documentation of WolffParkinson-White syndrome on electrocardiogram. He had a high likelihood of sudden cardiac death. Catheter ablation using CARTO TM system easily led to a successful ablation of the accessory pathway. The mechanism of late onset of the wide QRS tachycardia was attributed to possible changes of electrophysiologic properties including the atrio-ventricular node and/or the accessory pathway, and the unique location of the accessory pathway. Case ReportA 72-year-old man was admitted for evaluation of frequent syncope or fainting attacks which had suddenly begun 1 month before admission in May 2002. He easily experienced syncope attacks on exercise. Thus, his daily life activities were limited. He was taking antihypertensive drugs (5 mg of enalapril and 25 mg of atenolol), digitalis glycosides (0.125 mg of digoxin) and warfarin potassium as anticoagulant therapy for~10 years because of a history of cerebral infarction associated with hypertension and non-valvular chronic atrial fibrillation (Af). An electrocardiogram (ECG) taken 1 year prior to the admission was Af with narrow QRS complex ( Fig. 1A) with no evidence of tachycardia and delta waves (mean heart rate; 64 beats per minute, QRS; 82 msec). While the ECG taken 2 months prior to the admission showed Af with intermittent delta waves (mean heart rate; 60 beats per minute) ( Fig. 2A).On admission, his blood pressure was 102/64 mmHg and pulse rate was 124 beats per minute and irregular. When his heart rate was over 150 beats per minute on exercise, his systolic blood pressure dropped under 70 mmHg with manifestation of fainting. There were no murmurs on cardiac auscultation. Routine blood test results were almost normal except for a coagulation time. An ECG (Fig. 1B) showed wide QRS complex tachycardia (mean heart rate; 138 beats per minute, QRS; 134 msec) with a slur at the initial portion of the QRS complex. This tachycardia was suppressed by an intravenous administration of procainamide, which is known to depress the conduction of the accessory pathway (1), and resulted in a dramatic decrease of the wide QRS complex (Fig. 2B). By contrast, the tachycardia was accelerated by an intravenous application of verapamil or digitalis glycosides (Fig. 2C), which are reported to depress the conduction of the atrio-ventricular (AV) node (2, 3). With this change of ECG, the patient experienced symptoms of hypotension and notable fainting. These findings suggested that this patient might have Wolff-Parkinson-White (WPW) syndrome. A chest radiograph showed a mild increase of the cardiothoracic ratio (CTR; 54%) and two-dimensional echocardiography revealed no evidence of cardiac abnormalities except for mild dilatation of the left atrium, such as Ebstein's anomaly and mitral leaflet prolapse which are...

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“…Approximately 50% Of these patients have either manifest (i.e., WPW syndrome) or concealed accessory pathways supporting the tachycardia (ART) [19]. Although ART and WPW are both well known in infants [20][21][22][23][24][25] and are usually, but not always [16], benign, especially in the absence of structural heart disease, the tachycardia may either first occur or even reappear in the older child and adolescent. Thus WPW, as first described by Wolff, Parkinson, and White, is often a problem of the young.…”

Section: Discussionmentioning

confidence: 99%

“…It is important to note that these recommendations do not address the patient with fast conduction--determined by the measures outlined--but with no symptoms ( Figure 1D). Owing to the rarity of sudden deaths (0%-4%) [35] in older individuals with WPW, the even lower probable risk below the teenage years in the absence of heart disease [20][21][22][23][24], and the lack of specificity in identifying patients at risk, decisions regarding evaluation and treatment in these unusual patients must at present be individualized and perhaps considered investigational [42]. Although asymptomatic (i.e., no tachycardia) patients with both the WPW syndrome and fast conducting accessory pathways appear to be at risk for sudden death, and thus would possibly benefit from surgery in a manner similar to patients with an atrial septal defect or aortic stenosis who undergo surgery for the prevention of pulmonary vascular obstructive disease or sudden death, respectively, the natural history of this subset of WPW patients is not sufficiently characterized to justify a recommendation of surgery at this time.…”

Section: Discussionmentioning

confidence: 99%