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PO-01-014 NON-PERSISTENT VENTRICULAR PREEXCITATION IN CHILDREN WITH WOLFF-PARKINSON-WHITE: RESULTS FROM A MULTICENTER AMBISPECTIVE REGISTRY
Abstract   Peer reviewed

PO-01-014 NON-PERSISTENT VENTRICULAR PREEXCITATION IN CHILDREN WITH WOLFF-PARKINSON-WHITE: RESULTS FROM A MULTICENTER AMBISPECTIVE REGISTRY

Carolina A. Escudero, Cheyenne Beach, Iqbal El-Assaad, Reina B. Tan, Brynn E. Dechert-Crooks, Charles C. Anderson, Gaurav Arora, Peter F. Aziz, Andrew D. Blaufox, Ahmad S. Chaouki, …
Heart rhythm, Vol.22(4 Supplement), pp.S130-S130
04/2025
DOI: 10.1016/j.hrthm.2025.03.280

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Abstract

Background Patients with Wolff-Parkinson-White (WPW) syndrome can display persistent (PPx) or non-persistent (intermittent) ventricular preexcitation (NPx) on non-invasive testing. NPx has been associated with a lower risk of life-threatening events (LTEs). Comprehensive evaluations of differences in clinical characteristics between these groups are lacking. Objective This study sought to determine differences in clinical and electrophysiology study (EPS) characteristics between children with PPx and NPx. Methods We analyzed data from patients enrolled in a multicenter ambispective WPW registry from 2017-2024. Patients were included if they were 1-21 years of age at WPW presentation and had categorization as NPx or PPx. NPx was defined as loss of ventricular preexcitation on ECG, Holter, or telemetry, or abrupt loss on exercise testing. Clinical and EPS characteristics were compared between patients with NPx vs PPx. Rapidly-conducting accessory pathways (RC-APs) were defined as having an accessory pathway effective refractory period (APERP), shortest preexcited R-R interval (SPERRI) during atrial fibrillation at EPS, or shortest preexcited paced cycle length (SPPCL) ≤250 ms at baseline EPS. LTEs were defined as sudden death (SD), aborted SD, or clinical preexcited atrial fibrillation with SPERRI ≤250ms or hemodynamic instability. Results There were 1108/1302 patients in the registry who met the inclusion criteria: 864 with PPx (78%) and 244 with NPx (22%). Patients with PPx were older at presentation (11.6 [SD 5.4] vs 10.4 [SD 5.8] yrs, p<0.01) with no differences between groups in sex, race, or ethnicity. Patients with NPx more frequently had fetal SVT (8 vs 3%, p<0.01), presented with SVT (32 vs 22%, p<0.01), and required antiarrhythmics at presentation (19 vs 13%, p=0.01). Patients with NPx were less likely to undergo EPS (87 vs 92%, p=0.02) or risk stratification at EPS (83 vs 92%, p<0.01) than those with PPx. Mean APERP (304 [SD 53] vs 332 [SD 84]), SPERRI (318 [SD106] vs 377 [SD 160]), and SPPCL (305 [SD 69] vs 356 [SD 106]) were lower (p<0.01) for patients with PPx than NPx, with RC-APs in 27% with PPx and 17% (p=0.01) with NPx. LTEs occurred in 15 (1.8%) patients with PPx and 2 (0.8%) with NPx (p=0.39). Conclusion Patients with NPx presented at a younger age and more often with SVT. Patients with NPx had an overall lower, but clinically relevant, rate of RC-APs compared to PPx. Despite the occurrence of RC-APs in patients with NPx, patients were less likely to undergo EPS than those with PPx.

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