Journal article
Difficulties with invasive risk stratification performed under anesthesia in pediatric Wolff-Parkinson-White Syndrome
Heart rhythm, Vol.17(2), pp.282-286
02/01/2020
DOI: 10.1016/j.hrthm.2019.09.011
PMID: 31521806
Abstract
BACKGROUND Children with Wolff-Parkinson-White Syndrome (WPW) are at risk for sudden death. The gold standard for risk stratification in this population is the shortest pre-excited RR interval during atrial fibrillation (SPERRI).
OBJECTIVE The purpose of this study was to determine how closely measurements made in the electrophysiology laboratory in patients with WPW compared to SPERRI obtained during an episode of clinical pre-excited atrial fibrillation (Clinical-SPERRI).
METHODS This was a subgroup analysis of a multicenter study of children with WPW. Subjects in our study (N = 49) were included if they had Clinical-SPERRI measured in addition to 1 or more of 3 surrogate measurements: SPERRI obtained during electrophysiological study (EP-SPERRI), accessory pathway effective refractory period (APERP), or shortest pre-excited paced cycle length with 1:1 conduction (SPPCL).
RESULTS Seventy percent of electrophysiological measurements were made with patients under general anesthesia. Clinical-SPERRI moderately correlated with EP-SPERRI (r = 0.495; P = .012). However, 24% of our patients with Clinical-SPERRI <250 ms would have been misclassified as having a low-risk pathway based on EP-SPERRI >250 ms. Clinical-SPERRI did not correlate with APERP or SPPCL (r < 0.3; P >.1). Mean EP-SPERRI, APERP, and SPPCL all were greater than Clinical-SPERRI.
CONCLUSION Electrophysiology laboratory measurements of pathway characteristics made with patients under general anesthesia do not correlate well with Clinical-SPERRI. Of APERP, SPPCL, and EP-SPERRI, only EP-SPERRI had moderate correlation with Clinical-SPERRI. This study questions the predictive ability of invasive risk stratification with patients under general anesthesia, given that 24% of patients with high-risk Clinical-SPERRI (<= 250 ms) had EP-SPERRI that may be considered low risk (>250 ms).
Details
- Title: Subtitle
- Difficulties with invasive risk stratification performed under anesthesia in pediatric Wolff-Parkinson-White Syndrome
- Creators
- Mark H. Shwayder - University of UtahCarolina A. Escudero - Stollery Children's HospitalSusan P. Etheridge - University of UtahBrynn E. Dechert - University of Michigan–Ann ArborIan H. Law - University of Iowa Hospitals and ClinicsAndrew D. Blaufox - Cohen Children's Medical CenterJames C. Perry - Rady Children's Hospital-San DiegoAnne M. Dubin - Lucile Packard Children's HospitalShubhayan Sanatani - British Columbia Children's HospitalKathryn K. Collins - Children's Hospital Colorado
- Resource Type
- Journal article
- Publication Details
- Heart rhythm, Vol.17(2), pp.282-286
- Publisher
- Elsevier
- DOI
- 10.1016/j.hrthm.2019.09.011
- PMID
- 31521806
- ISSN
- 1547-5271
- eISSN
- 1556-3871
- Number of pages
- 5
- Language
- English
- Date published
- 02/01/2020
- Academic Unit
- Cardiology; Stead Family Department of Pediatrics
- Record Identifier
- 9984354054502771
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