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Risk stratification in the asymptomatic child with Wolff-Parkinson-White syndrome
1Pediatric Arrhythmia Center at University of California San Francisco and Stanford, Palo Alto and San Francisco, California, USA.
Insights
Established risk stratification criteria for adult Wolff-Parkinson-White syndrome may not apply to children. Invasive electrophysiologic studies are commonly used in pediatric patients, but further research is needed for accurate risk assessment.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Cardiac Arrhythmias
Background:
- Growing interest in risk stratification for asymptomatic pediatric Wolff-Parkinson-White syndrome (WPW) due to improved safety of invasive procedures.
- Adult risk stratification criteria may not be directly applicable to pediatric patients with WPW.
Purpose of the Study:
- To review recent literature on risk stratification criteria for asymptomatic pediatric patients with Wolff-Parkinson-White syndrome.
- To discuss the applicability of adult criteria and the role of invasive electrophysiologic studies and ablation in children.
Main Methods:
- Review of recent retrospective and prospective studies on pediatric Wolff-Parkinson-White syndrome.
- Analysis of invasive electrophysiologic study data, including accessory pathway effective refractory periods and supraventricular tachycardia inducibility.
- Examination of the first prospective evaluation of ablation therapy in asymptomatic patients.
Main Results:
- Asymptomatic and symptomatic pediatric patients with WPW showed similar accessory pathway effective refractory periods and inducibility of supraventricular tachycardia.
- Prospective studies suggest adult risk stratification criteria may not be suitable for pediatric populations.
- The utility and definition of high-risk patients for ablation in asymptomatic pediatric WPW remain debated.
Conclusions:
- There is ongoing controversy regarding the application of adult risk stratification criteria to pediatric Wolff-Parkinson-White syndrome.
- Pediatric electrophysiologists predominantly utilize invasive electrophysiologic studies for risk stratification and treatment selection.
- Further research is essential to establish precise risk stratification criteria for pediatric WPW, guiding indications for electrophysiologic study and ablation.
Purpose Of Review:
As the safety and efficacy of invasive electrophysiologic studies and ablation therapy in pediatrics improves, there has been a greater interest in developing adequate risk stratification criteria for the asymptomatic pediatric patient with Wolff-Parkinson-White syndrome. This review will discuss the recent literature regarding this debate.
Recent Findings:
Recent retrospective and prospective studies of Wolff-Parkinson-White syndrome in asymptomatic pediatric patients have shown that the well established adult criteria for risk stratification may not be applicable in children. Both symptomatic and asymptomatic children had similar accessory pathway effective refractory periods and supraventricular tachycardia inducibility in recent invasive electrophysiologic studies. The first attempt at prospective evaluation of the use of ablation therapy in asymptomatic adult and pediatric patients with the condition has sparked a debate as to the definition of a high-risk patient and the utility of ablation in the asymptomatic patient.
Summary:
It is still controversial whether the established criteria for risk stratification in adults can be confidently applied to the pediatric patient. The majority of pediatric electrophysiologists use invasive electrophysiologic studies for risk stratification and selection of appropriate therapy. This clinical practice reflects the increasing prevalence and safety of electrophysiologic study and ablation. Further studies to better define indications for study and ablation are still necessary, however, to define accurate criteria for risk stratification in this difficult pediatric problem.
