Related Experiment Video
Updated: Dec 30, 2025
Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System
Published on: April 11, 2025
Non-invasive Risk Stratification in Pediatric Ventricular Pre-excitation
Rana Khaznadar1, Stephanie F Chandler1, A Sami Chaouki1
1Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 21, Chicago, IL, 60611, USA.
Insights
Non-invasive risk stratification for children with ventricular pre-excitation has low sensitivity and is a poor predictor of invasive findings. Cardiologists should consider invasive electrophysiology study and ablation for these patients.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Sudden Cardiac Death Risk Stratification
Background:
- Children with ventricular pre-excitation face risks, including sudden death.
- Electrophysiology study (EPS) is used for risk stratification in these patients.
- Non-invasive methods are often employed before invasive procedures.
Purpose of the Study:
- To evaluate the performance of non-invasive risk stratification in pediatric patients with ventricular pre-excitation.
- To compare time to invasive risk stratification between symptomatic and asymptomatic groups.
- To inform clinical practice regarding risk assessment strategies.
Main Methods:
- Retrospective study of pediatric patients (>8 years) undergoing EPS.
- Patients divided into two groups based on symptoms and documented arrhythmias.
- Analysis of sensitivity, specificity, positive, and negative predictive values of non-invasive stratification.
Main Results:
- Non-invasive risk stratification showed low sensitivity (7%) and high specificity (91%).
- Positive predictive value was 14%, and negative predictive value was 84%.
- Most patients, even those with severe symptoms, underwent non-invasive assessment prior to EPS.
Conclusions:
- Non-invasive risk stratification is an unreliable predictor of invasive findings in pediatric ventricular pre-excitation.
- Cardiologists should discuss these limitations with families.
- Consideration of primary invasive electrophysiology study and ablation may be warranted.
Abstract:
Children with ventricular pre-excitation are at risk for sudden death. This retrospective pediatric study identified patients > 8 years of age who had undergone electrophysiology study (EPS). Our primary objective was to determine the performance characteristics of non-invasive risk stratification. Subjects were separated into two groups. Group 1 was asymptomatic or had non-specific symptoms (palpitations, chest pain, and light headedness) without documented supraventricular tachycardia (SVT). Group 2 had syncope, documented SVT, or a life-threatening event. As a secondary aim, we tested whether patients with severe symptoms had a shorter time from the date of diagnosis to the date of invasive risk stratification. Among 93 patients with an average age of 14.2 years, 25 patients had documented SVT, 6 had syncope, and 1 had a life-threatening event. The sensitivity of non-invasive risk stratification was 7%. The specificity was 91%. The positive predictive valve was 14% and the negative predictive value was 84%. Even patients with severe symptoms commonly underwent non-invasive risk stratification prior to EPS, albeit at a lower rate (Group 1, 98%; Group 2 84%, p = 0.02). The median time to EPS was 4.2 months (Group 1) and 4.5 months (Group 2, p = 0.63). Non-invasive risk stratification was a poor predictor of invasive risk stratification. Cardiologists should counsel families about the limitations of non-invasive risk stratification and consider starting with invasive risk stratification and possible ablation. Counterintuitively, severe symptoms were not associated with a shorter time to electrophysiology study.
