Abstract
PO-01-013 ISOPROTERENOL EFFECT IN THE EVALUATION OF PEDIATRIC WOLFF-PARKINSON-WHITE: RESULTS FROM A MULTICENTER AMBISPECTIVE REGISTRY
Heart rhythm, Vol.22(4 Supplement), pp.S129-S130
04/2025
DOI: 10.1016/j.hrthm.2025.03.279
Abstract
Background
Electrophysiology study (EPS) is the gold standard for Wolff–Parkinson–White (WPW) risk stratification. The impact of isoproterenol (ISO) on accessory pathway (AP) risk stratification is unclear.
Objective
Assess the effect of isoproterenol on accessory pathway risk stratification in children.
Methods
WPW subjects ≤21 years from a multicenter database (2017– 2024) were grouped by ISO use during EPS. Only first-documented EPS were included. Clinical and EPS characteristics including life-threatening events (LTEs), AP effective refractory period (APERP), shortest preexcited R-R interval (SPERRI), and shortest preexcited paced cycle length (SPPCL) were compared. High-risk APs were defined as APERP, SPERRI, or SPPCL ≤250ms. LTEs included sudden death (SD), aborted SD, or clinical preexcited atrial fibrillation (AF) with SPERRI ≤250ms or hemodynamic instability.
Results
Among 1030 patients, ISO was used in 583 (56.6%), with institutional use varying from 9.7%-98.0%. The ISO group was older at EPS (13.5 vs 12.9 yrs, p=0.038). There were 17 (1.7%) with LTE with no difference between groups (10 (1.7%) ISO vs 7 (1.6%) non-ISO). There was no difference in EPS anesthesia type.
Risk stratification was performed in 937 patients (91%), with 521 (55.6%) assessed at baseline only, 401 (42.8%) at baseline and with ISO, and 15 (1.3%) with ISO only. High-risk APs were more frequent at baseline in the non-ISO group (29.3% vs. 22.0%, p=0.011). The mean ISO dose was 0.043 mcg/kg/min (range 0.005-0.244), increasing HR by a mean of 45.6±23.9 bpm. High-risk APs were more common with ISO (65.4 vs 24.8%, p <0.001). Among those receiving ISO, 32.4% remained low-risk, 22.5% remained high-risk, 45.6% changed from low- to high-risk, and 2.1% changed from high- to low-risk. Age negatively correlated with changes in APERP (r=-0.130, p=0.026) and SPPCL with ISO (r=-0.121, p=0.030). High-risk APs were significantly more frequent at baseline in patients with LTE than in those without LTE (70.6% vs. 24.5%, p<0.001), however this difference was not observed with ISO (75.0% vs. 65.6%, p=0.72).
Conclusion
Isoproterenol significantly alters accessory pathway conduction in children, reclassifying nearly half of low-risk APs as high-risk. Performing EPS without isoproterenol may fail to recognize potentially malignant accessory pathways. Isoproterenol does not significantly improve the detection of patients with prior LTE.
Details
- Title: Subtitle
- PO-01-013 ISOPROTERENOL EFFECT IN THE EVALUATION OF PEDIATRIC WOLFF-PARKINSON-WHITE: RESULTS FROM A MULTICENTER AMBISPECTIVE REGISTRY
- Creators
- Reina B. TanMary C. NiuCheyenne BeachIqbal El-AssaadBrynn E. Dechert-CrooksCharles C. AndersonGaurav AroraPeter F. AzizAndrew D. BlaufoxAhmad S. ChaoukiChristopher C. EricksonDavid GamboaChristopher M. JansonPrince J. KannankerilNaomi J. KerteszIan H. LawLindsey E. Malloy-WaltonShubhayan SanataniJayaprakash ShentharElizabeth A. StephensonRonn E. TanelNicholas H. Von BergenSusan P. EtheridgeCarolina A. Escudero
- Resource Type
- Abstract
- Publication Details
- Heart rhythm, Vol.22(4 Supplement), pp.S129-S130
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.hrthm.2025.03.279
- ISSN
- 1547-5271
- Language
- English
- Date published
- 04/2025
- Academic Unit
- Cardiology; Stead Family Department of Pediatrics
- Record Identifier
- 9984816017602771
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