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 - 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
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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 -