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

Area of Science:

• Pediatric Cardiology
• Clinical Electrophysiology
• Cardiac Electrophysiology

Background:

• The management of asymptomatic pediatric Wolff-Parkinson-White (WPW) patients lacks a definitive consensus.
• Previous guidelines from the Pediatric and Congenital Electrophysiology Society/Heart Rhythm Society require updates based on recent evidence.

Purpose of the Study:

• To provide an updated evidence-based summary on managing young patients with asymptomatic WPW patterns.
• To inform clinical decision-making and potentially refine future consensus guidelines.

Main Methods:

• A systematic literature review was conducted for studies published between 2008 and 2018.
• Databases searched included PubMed, Cochrane, Embase, and Web of Science, adhering to PRISMA guidelines.
• Eligible study designs encompassed observational, experimental, and multicentric research.

Main Results:

• The shortest pre-excitatory RR interval (SPERRI) ≤250 ms emerged as the strongest predictor for risk stratification in asymptomatic WPW.
• Routine use of isoprenaline during electrophysiological studies was consistently recommended to enhance the identification of high-risk individuals.
• Prophylactic ablative therapy is indicated for asymptomatic children with accessory pathways (APs) exhibiting a low SPERRI, short effective anterograde AP refractory period, or multiple APs.

Conclusions:

• Current evidence supports risk stratification using SPERRI and electrophysiological parameters to guide interventions in asymptomatic pediatric WPW.
• While prophylactic ablation is increasingly indicated for high-risk cases, further research is necessary to solidify management strategies.
• The findings highlight the need for ongoing investigation into optimal care pathways for these young patients.