Risk Factors Associated With Ventricular Dysfunction in Wolff-Parkinson-White Syndrome

Wolff-Parkinson-White (WPW) syndrome is associated with ventricular dysfunction in the absence of sustained tachyarrhythmias. Our aim was to determine the prevalence of ventricular dysfunction and to assess risk factors associated with this condition.

A single-centre retrospective analysis of all patients <18 years of age with WPW syndrome and normal cardiac anatomy who underwent an electrophysiology study ablation over a 14-year period was performed. Patients with an ejection fraction <55% were defined as having ventricular dysfunction.

Among 305 patients, 14 cases (4.5%) with ventricular dysfunction were identified. In 4 of 14 cases (28%), the presenting symptom was heart failure, and only 6 of 14 (43%) had symptoms of palpitations or documented supraventricular tachycardia. The vast majority of patients with dysfunction had right-sided pathways, and only 2 patients had a left-sided pathway locations. Right anteroseptal, anterior, and anterolateral accessory pathway locations were more common in the dysfunction group. The presence of multiple pathways and pathway characteristics assessed during electrophysiology study were comparable between the 2 groups.

The prevalence of ventricular dysfunction in WPW syndrome in children was 4.5%, and this is seen more frequently with right anteroseptal, anterior, and anterolateral pathway locations. Risk analysis identified these pathway locations to be associated with a 4-fold risk of developing ventricular dysfunction (odds ratio: 4.32 [confidence interval: 1.38-14.18], P = 0.012). Because of this rare complication, serial assessment of ventricular function is recommended regardless of arrhythmia burden and an ablation should be considered in the presence of dysfunction.