TY - JOUR
T1 - Loss of ventricular preexcitation during noninvasive testing does not exclude high-risk accessory pathways
T2 - A multicenter study of WPW in children
AU - Escudero, Carolina A.
AU - Ceresnak, Scott R.
AU - Collins, Kathryn K.
AU - Pass, Robert H.
AU - Aziz, Peter F.
AU - Blaufox, Andrew D.
AU - Ortega, Michel Cabrera
AU - Cannon, Bryan C.
AU - Cohen, Mitchell I.
AU - Dechert, Brynn E.
AU - Dubin, Anne M.
AU - Motonaga, Kara S.
AU - Epstein, Michael R.
AU - Erickson, Christopher C.
AU - Fishberger, Steven B.
AU - Gates, Gregory J.
AU - Capone, Christine A.
AU - Nappo, Lynn
AU - Kertesz, Naomi J.
AU - Kim, Jeffrey J.
AU - Valdes, Santiago O.
AU - Kubuš, Peter
AU - Law, Ian H.
AU - Maldonado, Jennifer
AU - Moore, Jeremy P.
AU - Perry, James C.
AU - Sanatani, Shubhayan
AU - Seslar, Stephen P.
AU - Shetty, Ira
AU - Zimmerman, Frank J.
AU - Skinner, Jonathan R.
AU - Marcondes, Luciana
AU - Stephenson, Elizabeth A.
AU - Asakai, Hiroko
AU - Tanel, Ronn E.
AU - Uzun, Orhan
AU - Etheridge, Susan P.
AU - Janson, Christopher M.
N1 - Funding Information:
Dr Kubuš was supported by the Ministry of Health , Czech Republic—conceptual development of research organization, Motol University Hospital, Prague, Czech Republic (grant no. 00064203 ). The rest of the authors report no conflicts of interest
Funding Information:
Dr Kubu? was supported by the Ministry of Health, Czech Republic?conceptual development of research organization, Motol University Hospital, Prague, Czech Republic (grant no. 00064203). The rest of the authors report no conflicts of interest
Publisher Copyright:
© 2020 Heart Rhythm Society
PY - 2020/10
Y1 - 2020/10
N2 - Background: 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. Objective: 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. Methods: 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. Results: 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). Conclusion: 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.
AB - Background: 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. Objective: 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. Methods: 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. Results: 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). Conclusion: 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.
KW - Children
KW - Exercise testing
KW - Life-threatening event
KW - Noninvasive evaluation
KW - Pediatric
KW - Pediatric and Congenital Electrophysiology Society (PACES)
KW - Wolff-Parkinson-White syndrome
UR - http://www.scopus.com/inward/record.url?scp=85091253763&partnerID=8YFLogxK
U2 - 10.1016/j.hrthm.2020.05.035
DO - 10.1016/j.hrthm.2020.05.035
M3 - Article
C2 - 32497761
AN - SCOPUS:85091253763
SN - 1547-5271
VL - 17
SP - 1729
EP - 1737
JO - Heart Rhythm
JF - Heart Rhythm
IS - 10
ER -