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Clinical and electrophysiological evaluation of pediatric Wolff-Parkinson-White patients
Işıl Yıldırım1, Sema Özer, Tevfik Karagöz
1Department of Pediatric Cardiology, Adana Numune Teaching and Research Hospital; Adana-Turkey. isilyildirim93@gmail.com.
Insights
Wolff-Parkinson-White (WPW) syndrome in children may have a more serious prognosis than previously believed. Electrophysiological assessment and risk stratification are crucial for managing WPW patients and preventing sudden death.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Cardiac Arrhythmias
Background:
- Wolff-Parkinson-White (WPW) syndrome is characterized by supraventricular tachycardia and specific electrocardiogram (ECG) findings.
- Limited data exists on the electrophysiological properties and management algorithms for pediatric WPW patients, especially in resource-limited settings.
Purpose of the Study:
- To evaluate the electrophysiological characteristics of pediatric patients diagnosed with WPW syndrome.
- To develop a management algorithm for these patients, considering limited access to electrophysiological studies.
Main Methods:
- Retrospective review of pediatric patients undergoing electrophysiological evaluation for WPW syndrome.
- Analysis of patient demographics, presenting symptoms, electrophysiological findings, and ablation outcomes.
Main Results:
- 109 pediatric patients were evaluated; 82 presented with tachycardia, 14 with syncope, and 13 were asymptomatic.
- Ventricular fibrillation (VF) was induced in 2 patients, both with accessory pathway effective refractory periods ≤180 ms.
- Ablation success rate was 90.5%, with a recurrence rate of 23.8%; ablation was not attempted in 8.6% due to risk of atrioventricular block.
Conclusions:
- The occurrence of VF in pediatric WPW patients suggests a potentially more severe prognosis than previously assumed.
- Electrophysiological assessment and risk stratification are recommended for all children with a WPW pattern on ECG.
- Risk-factor-guided ablation can effectively prevent sudden cardiac death in this pediatric population.
Objective:
Wolff-Parkinson-White (WPW) syndrome presents with paroxysmal supraventricular tachycardia and is characterized by electrocardiographic (ECG) findings of a short PR interval and a delta wave. The objective of this study was to evaluate the electrophysiological properties of children with WPW syndrome and to develop an algorithm for the management of these patients with limited access to electrophysiological study.
Methods:
A retrospective review of all pediatric patients who underwent electrophysiological evaluation for WPW syndrome was performed.
Results:
One hundred nine patients underwent electrophysiological evaluation at a single tertiary center between 1997 and 2011. The median age of the patients was 11 years (0.1-18). Of the 109 patients, 82 presented with tachycardia (median age 11 (0.1-18) years), and 14 presented with syncope (median age 12 (6-16) years); 13 were asymptomatic (median age 10 (2-13) years). Induced AF degenerated to ventricular fibrillation (VF) in 2 patients. Of the 2 patients with VF, 1 was asymptomatic and the other had syncope; the accessory pathway effective refractory period was ≤180 ms in both. An intracardiac electrophysiological study was performed in 92 patients, and ablation was not attempted for risk of atrioventricular block in 8 (8.6%). The success and recurrence rate of ablation were 90.5% and 23.8% respectively.
Conclusion:
The induction of VF in 2 of 109 patients in our study suggests that the prognosis of WPW in children is not as benign as once thought. All patients with a WPW pattern on the ECG should be assessed electrophysiologically and risk-stratified. Ablation of patients with risk factors can prevent sudden death in this population.
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