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Pre-excitation cardiac problems in children: recognition and treatment
1Department of Pediatric Cardiology, Heart Center, the First Hospital of Tsinghua University (Beijing Huaxin Hospital), School of Clinical Medicine, Tsinghua University, No.6 Jiuxianqiao 1st Road, Chaoyang district, Beijing, 100016, China.
Insights
Ventricular pre-excitation in children can cause dilated cardiomyopathy, even without tachycardia. Catheter ablation is now the preferred treatment for this condition in pediatric patients.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Cardiomyopathy
Background:
- Ventricular pre-excitation affects 0.07-0.2% of children, with Kent bundles being common and Mahaim fibers rare.
- Persistent atrioventricular reentrant tachycardia in children can lead to tachycardiomyopathy.
- Limited antiarrhythmic drug options exist for pediatric patients.
Purpose of the Study:
- To highlight accessory pathway-induced dilated cardiomyopathy in children.
- To discuss treatment options for ventricular pre-excitation in pediatric patients with dilated cardiomyopathy.
Main Methods:
- Review of existing literature on ventricular pre-excitation and cardiomyopathy in children.
- Analysis of the role of accessory pathways in cardiac dysfunction.
- Evaluation of current treatment modalities, including antiarrhythmic drugs and catheter ablation.
Main Results:
- Anterograde conduction via right accessory pathways can cause ventricular systolic dyssynchrony and dilated cardiomyopathy, independent of tachycardia onset.
- Catheter ablation techniques, including radiofrequency and cryoablation, have advanced significantly for pediatric use.
- Catheter ablation is increasingly the first-line treatment for pediatric pre-excitation syndrome.
Conclusions:
- Differential diagnosis between tachycardiomyopathy and accessory pathway-induced dilated cardiomyopathy is crucial in children with ventricular pre-excitation and cardiomyopathy.
- Catheter ablation (radiofrequency and cryoablation) is a safe and effective first-line treatment for pediatric ventricular pre-excitation.
Abstract:
The prevalence of ventricular pre-excitation is 0.07-0.2% in the pediatric population. Kent bundle is the most common atrioventricular accessory pathway and Mahaim fiber is relatively rare. Approximately, 30-60% of children with ventricular pre-excitation have onset of atrioventricular reentrant tachycardia. Persistent atrioventricular reentrant tachycardia can lead to tachycardiomyopathy. The anterograde conduction of right accessory pathway might lead to ventricular systolic dyssynchrony which might result in cardiac dysfunction even in patients with no tachycardia onset. This type of dilated cardiomyopathy was named as accessory pathway-induced dilated cardiomyopathy. Antiarrhythmic drugs can be used to acutely terminate tachycardia or taken orally to decrease tachycardia recurrence in the long term. However, antiarrhythmic drugs that can be chosen for children are quite limited. Sotalol has become a new choice. With the maturation of radiofrequency catheter ablation technique, progress in three-dimensional electro-anatomic mapping, use of cryoablation, and accumulation of experience in children with small age and weight, catheter ablation has become the first choice for children with pre-excitation syndrome.Conclusion: For ventricular pre-excitation co-exists with dilated cardiomyopathy, differential diagnosis of tachycardiomyopathy or accessory pathway-induced dilated cardiomyopathy should be considered. Catheter ablation (radiofrequency and cryoablation) is a relatively safe and effective treatment option and has become the first choice to treat children with ventricular pre-excitation. What is Known: • Persistent atrioventricular reentrant tachycardia in children can lead to tachycardiomyopathy; • Antiarrhythmic drugs that can be chosen for children are quite limited. What is New: • The anterograde conduction of right accessory pathway (not related to supraventricular tachycardia) might lead to accessory pathway-induced dilated cardiomyopathy. • Catheter ablation (including radiofrequency and cryoablation) has become the first choice for children with pre-excitation syndrome.
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