UNCORRECTED PROOF-IN PROCESS Original Investigation Clinical and electrophysiological evaluation of pediatric Wolff- Parkinson-White patients

Abstract

Objective: Wolff-Parkinson-White (WPW) syndrome presents with paroxysmal supraventricular tachycardia and is characterized with electrocardiographic (ECG) findings of a short PR interval and a delta wave. The objective of this study was to evaluate the electrophysiological properties of children with WPW syndrome and to develop an algorithm for management of these patients with limited access to electrophysiological study. Methods: A retrospective review of all pediatric patients who underwent electrophysiological evaluation for WPW syndrome was performed. Results: One hundred and nine patients underwent electrophysiological evaluation at a single tertiary center between 1997 and 2011. The median age of the patients was 11 years (0.1-18). Of the 109 patients, 82 presented with tachycardia, 14 with syncope; 13 were asymptomatic. Atrial fibrillation (AF) was induced in 6 of the tachycardia patients, 5 of the syncope patients and 1 of the asymptomatic patients. Induced AF degenerated to ventricular fibrillation (VF) in 2 patients. Of the two patients with VF one was asymptomatic and the other had syncope, the accessory pathway effective refractory period was ≤180 ms in both. Intracardiac electrophysiologic study was performed in 92 patients and ablation was not attempted for risk of atrioventricular block in 8 (8.6%). Success rate of ablation was 90.5%. Conclusion: Induction of VF in 2 of 109 patients in our study suggests that the prognosis of WPW in children is not as benign as once it was thought. All patients with WPW pattern on ECG should be electrophysiologically assessed and risk stratified. Ablation of patients with risk factors can prevent sudden death in this population. (Anadolu Kardiyol Derg 2014; 14(0): 000-000