Abstract
Abstract 10628: The Effect of Isoproterenol Use on Accessory Pathway Conduction Characteristics in Wolff-Parkinson-White Syndrome in Children
Circulation (New York, N.Y.), Vol.140(Suppl_1 Suppl 1), pp.A10628-A10628
11/19/2019
DOI: 10.1161/circ.140.suppl_1.10628
Abstract
IntroductionUncertainty remains regarding the utility of isoproterenol (ISO) testing for risk stratification in children with Wolff-Parkinson-White syndrome (WPW).HypothesisISO use during invasive electrophysiology study (EPS) would increase sensitivity and decrease specificity of identifying children who had a life-threatening event (LTE) in a large cohort of children with WPW.MethodsPatients ≤ 21 years with WPW who underwent EPS with risk stratification using ISO were identified from 2 multicenter databases. EPS risk stratification data and occurrence of LTE were collected. AP effective refractory period (APERP), shortest preexcited RR interval (SPERRI) in atrial fibrillation at EPS (EPS-SPERRI), and shortest pre-excited paced cycle length (SPPCL) were compared at baseline and with ISO. A rapidly conducting AP (rapid-AP) was defined as APERP, SPERRI, or SPPCL ≤ 250ms. LTE was defined as aborted sudden death or clinical preexcited atrial fibrillation with SPERRI ≤ 250ms.ResultsThere were 442 patients included with mean age 13.4±3.9 years, 18 (4%) with a LTE. At baseline, rapid-APs were seen more frequently in patients with LTE (50 vs 12%, p<0.001). With ISO, mean APERP (327±64 vs 272±53ms, p<0.001), EPS-SPERRI (330±83 vs 277±62ms, p<0.001), and SPPCL (341±90 vs 270±66ms, p<0.001) shortened. There was no difference in the proportion of rapid-APs between patients with and without LTE on ISO (78 vs 57%, p=0.09). In non-LTE patients, 53% were reclassified as having a rapid-AP on ISO. Rapid-AP classification at baseline compared to ISO has a sensitivity of 50% (95% CI 27-73%) vs 78% (95% CI 52-93%) [p=0.125] and specificity of 88% (95% CI 85-91%) vs 43% (95% CI 39-48%) [p<0.01] for identifying patients with a history of LTE. General anesthesia was used in 93% of patients and was not associated with rapid-AP at baseline or with ISO (p>0.067).ConclusionsThe use of ISO at EPS increases the sensitivity but decreases the specificity of identifying patients with prior LTE, with more than half of non-LTE patients reclassified as rapid-AP.
Details
- Title: Subtitle
- Abstract 10628: The Effect of Isoproterenol Use on Accessory Pathway Conduction Characteristics in Wolff-Parkinson-White Syndrome in Children
- Creators
- Carolina Escudero - University of AlbertaScott Ceresnak - Stanford UniversityKathryn Collins - Pediatric Arrhythmia Cntr, Children’s Hosp of Colorado, Aurora, CORobert Pass - The Bronx DefendersPeter Aziz - Cleveland ClinicAndrew Blaufox - Cohen Children's Medical CenterMichel Cabrera Ortega - Pediatric Cardiology, Cardiocentro Pediátrico William Soler, La Habana, CubaBryan Cannon - Mayo ClinicMitchell Cohen - Inova Children's HospitalBrynn Dechert-Crooks - University of Michigan–Ann ArborAnne Dubin - Standford Univ Sch Medicine, Palo Alto, CAKara Motonaga - Stanford UniversityMichael Epstein - Maine Medical CenterChristopher Erickson - Pediatric Cardiology, Children’s Specialty Physicians/UNMC/CUMC, Omaha, NESteven Fishberger - Miami Children’s Hosp, Miami, FLGregory Gates - Children’s Hosp of NY, New York, NYChristine Capone - The Children s Hosp at Montefiore, White Plains, NYLynn Nappo - The Bronx DefendersNaomi Kertesz - Nationwide Childrens Hosp, Columbus, OHJeffrey Kim - Texas Children’s Hosp, Houston, TXSantiago Valdes - Texas Childrens Hosp, Houston, TXPeter Kubus - Pediatric Cardiology, Children’s Heart Cntr, Prague, Czech RepublicIan Law - University of IowaJennifer Maldonado - University of IowaJeremy Moore - UCLA Children’s Health Cntr, Los Angeles, CAJames Perry - UCSD Rady Childrens Hosp, San Diego, CAShubhayan Sanatani - British Columbia, Vancouver, CanadaStephen Seslar - Seattle Childrens Hosp, Seattle, WAIra Shetty - Pediatric Cardiology, Advocate Childrens Hosp, Oak Lawn, ILFrank Zimmerman - Advocate Childrens Hosp, Oak Lawn, ILJon Skinner - Pediatric Cardiology, Starship Children’s Hosp, Auckland, New ZealandLuciana Marcondes - Starship Childrens hospital, Auckland, New ZealandElizabeth Stephenson - The Hosp for Sick Children, Toronto, CanadaHiroko Asakai - Hosp for Sick Children, Toronto, CanadaRonn Tanel - UC San Francisco, San Francisco, CAOrhan Uzun - Pediatric Cardiology, Univ Hosp of Wales, Cardiff, United KingdomSusan Etheridge - PEDIATRIC CARDIOLOGY, PCOS Eccles Building, Salt Lake Cty, UTChristopher Janson - Children’s Hosp of Philadelphia, Philadelphia, PA
- Resource Type
- Abstract
- Publication Details
- Circulation (New York, N.Y.), Vol.140(Suppl_1 Suppl 1), pp.A10628-A10628
- Publisher
- by the American College of Cardiology Foundation and the American Heart Association, Inc
- DOI
- 10.1161/circ.140.suppl_1.10628
- ISSN
- 0009-7322
- eISSN
- 1524-4539
- Language
- English
- Date published
- 11/19/2019
- Academic Unit
- Stead Family Department of Pediatrics; Cardiology
- Record Identifier
- 9984354392002771
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