Journal article
Loss of ventricular preexcitation during noninvasive testing does not exclude high-risk accessory pathways: A multicenter study of WPW in children
Heart rhythm, Vol.17(10), pp.1729-1737
10/2020
DOI: 10.1016/j.hrthm.2020.05.035
PMID: 32497761
Abstract
Abrupt loss of ventricular preexcitation on noninvasive evaluation, or nonpersistent preexcitation, in Wolff-Parkinson-White syndrome (WPW) is thought to indicate a low risk of life-threatening events.
The purpose of this study was to compare accessory pathway (AP) characteristics and occurrences of sudden cardiac arrest (SCA) and rapidly conducted preexcited atrial fibrillation (RC-AF) in patients with nonpersistent and persistent preexcitation.
Patients 21 years or younger with WPW and invasive electrophysiology study (EPS) data, SCA, or RC-AF were identified from multicenter databases. Nonpersistent preexcitation was defined as absence/sudden loss of preexcitation on electrocardiogram, Holter monitoring, or exercise stress test. RC-AF was defined as clinical preexcited atrial fibrillation with shortest preexcited R-R interval (SPERRI) ≤ 250 ms. AP effective refractory period (APERP), SPERRI at EPS , and shortest preexcited paced cycle length (SPPCL) were collected. High-risk APs were defined as APERP, SPERRI, or SPPCL ≤ 250 ms.
Of 1589 patients, 244 (15%) had nonpersistent preexcitation and 1345 (85%) had persistent preexcitation. There were no differences in sex (58% vs 60% male; P=.49) or age (13.3±3.6 years vs 13.1±3.9 years; P=.43) between groups. Although APERP (344±76 ms vs 312±61 ms; P<.001) and SPPCL (394±123 ms vs 317±82 ms; P<.001) were longer in nonpersistent vs persistent preexcitation, there was no difference in SPERRI at EPS (331±71 ms vs 316±73 ms; P=.15). Nonpersistent preexcitation was associated with fewer high-risk APs (13% vs 23%; P<.001) than persistent preexcitation. Of 61 patients with SCA or RC-AF, 6 (10%) had nonpersistent preexcitation (3 SCA, 3 RC-AF).
Nonpersistent preexcitation was associated with fewer high-risk APs, though it did not exclude the risk of SCA or RC-AF in children with WPW.
Details
- Title: Subtitle
- Loss of ventricular preexcitation during noninvasive testing does not exclude high-risk accessory pathways: A multicenter study of WPW in children
- Creators
- Carolina A. Escudero - Stollery Children's HospitalScott R. Ceresnak - Lucile Packard Children's HospitalKathryn K. Collins - University of Colorado DenverRobert H. Pass - Children's Hospital at MontefiorePeter F. Aziz - Cleveland Clinic Lerner College of MedicineAndrew D. Blaufox - Cohen Children's Medical CenterMichel Cabrera Ortega - Atlas CopcoBryan C. Cannon - Mayo ClinicMitchell I. Cohen - Inova Children's HospitalBrynn E. Dechert - University of Michigan–Ann ArborAnne M. Dubin - Lucile Packard Children's HospitalKara S. Motonaga - Lucile Packard Children's HospitalMichael R. Epstein - Maine Medical CenterChristopher C. Erickson - Children's Hospital & Medical CenterSteven B. Fishberger - Miami Children's HospitalGregory J. Gates - Children's Hospital at MontefioreChristine A. Capone - Children's Hospital at MontefioreLynn Nappo - Children's Hospital at MontefioreNaomi J. Kertesz - Nationwide Children's HospitalJeffrey J. Kim - Texas Children's HospitalSantiago O. Valdes - Texas Children's HospitalPeter Kubuš - Charles UniversityIan H. Law - University of IowaJennifer Maldonado - University of IowaJeremy P. Moore - Ronald Reagan UCLA Medical CenterJames C. Perry - Rady Children's Hospital-San DiegoShubhayan Sanatani - University of British ColumbiaStephen P. Seslar - Seattle Children's HospitalIra Shetty - Advocate Children's HospitalFrank J. Zimmerman - Advocate Children's HospitalJonathan R. Skinner - Starship Children's HealthLuciana Marcondes - Starship Children's HealthElizabeth A. Stephenson - Hospital for Sick ChildrenHiroko Asakai - University of Tokyo HospitalRonn E. Tanel - UCSF Benioff Children's HospitalOrhan Uzun - University Hospital of WalesSusan P. Etheridge - Primary Children's HospitalChristopher M. Janson - Children's Hospital at Montefiore
- Resource Type
- Journal article
- Publication Details
- Heart rhythm, Vol.17(10), pp.1729-1737
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.hrthm.2020.05.035
- PMID
- 32497761
- ISSN
- 1547-5271
- eISSN
- 1556-3871
- Grant note
- 00064203 / Ministry of Health (https://doi.org/10.13039/100009647)
- Language
- English
- Date published
- 10/2020
- Academic Unit
- Cardiology; Stead Family Department of Pediatrics
- Record Identifier
- 9984353888202771
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