Related Experiment Videos
[Long-term follow-up on ventricular pre-excitation in pediatric age]
L De Simone1, I Pollini, S Favilli
1U.O. Cardiologia Azienda Ospedaliera Anna Meyer, Firenze.
Insights
Pediatric ventricular pre-excitation is generally benign but can cause heart failure in infants. Electrophysiologic studies assess arrhythmia risk, and ablative therapy shows lower efficacy in children.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Arrhythmology
Background:
- Ventricular pre-excitation in pediatric patients is not well understood clinically.
- Assessing malignant arrhythmia risk and ablation indications requires further study.
Purpose of the Study:
- To define the clinical course of pediatric ventricular pre-excitation.
- To assess the risk of malignant arrhythmias.
- To evaluate indications for ablative therapy.
Main Methods:
- Studied 82 pediatric patients with ventricular pre-excitation.
- Mean follow-up of 66 months.
- Transesophageal electrophysiologic study in 22 patients.
Main Results:
- 68.3% of patients were asymptomatic.
- 34.1% experienced atrio-ventricular tachycardia; 5 had syncope or cardiac failure.
- Electrophysiologic study induced tachyarrhythmias in 15/22 patients, identifying risk in 13.6%.
Conclusions:
- The clinical course is generally benign, but infants may experience cardiac failure or syncope.
- Electrophysiologic studies are sensitive for risk assessment but have low predictive accuracy.
- Catheter ablation efficacy is lower in children than adults.
Aim:
Little is known yet about the clinical aspects of ventricular pre-excitation in pediatric age. In order to define clinical course, assess the risk of malignant arrhythmia and evaluate indications for ablative therapy, we studied 82 consecutive pediatric patients (pts) with this affection (61 males-21 females; mean age at diagnosis 5.1 years, range 1 day-15 years).
Results:
Mean follow-up time was 66 months (range 3-252). Fifty-six pts (68.3%) were asymptomatic. One patient, who was affected with hypertrophic cardiomyopathy and died suddenly when she was 2 while her cardiac rhythm was being monitored, had an EKG pattern of asystolia. In 28 pts (19 m - 9 f, 34.1%), episodes of reentrant atrio-ventricular tachycardia, ranging from 160 to 320 beats/minute, were documented. Five pts, four of whom were less than 1 year old, had syncope or cardiac failure due to tachyarrhythmia. As far as maximum incidence of symptoms is concerned, two peaks were observed: within the first year and between 14 and 16 years of age. A transesophageal electrophysiologic study was performed in 22 pts, tachyarrhythmias were induced in 15, and risk criteria were satisfied in 3/22 (13.6%). Five pts underwent catheter ablation of an accessory pathway and this was successful in three of them.
Conclusions:
The clinical course in this series of patients has been benign. Nevertheless, during the first year of life cardiac failure or syncope may occur because of high heart rates. The transesophageal electrophysiologic study, which is also easy to perform in pediatric patients, has been sensitive in assessing the risk of malignant arrhythmia, but it shows low predictive accuracy. Lastly, ablative therapy has shown lower efficacy in children than in adult patients.