Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-23T05:09:15.710Z Has data issue: false hasContentIssue false
  • English
  • Français

Clinical and electrophysiologic evolution of the Wolff-Parkinson-White syndrome in children: impact on approaches to management

Published online by Cambridge University Press:  19 August 2008

Gabriele Vignati ,
Eva Balla ,
Luigi Mauri ,
Maurizio Lunati  and
Alberto Figini
Gabriele Vignati
Affiliation:
Pediatric Cardiology Service, Department of Cardiology “De'Gasperis”, Niguarda Hospital, Milan, Italy
Eva Balla
Affiliation:
Pediatric Cardiology Service, Department of Cardiology “De'Gasperis”, Niguarda Hospital, Milan, Italy
Luigi Mauri
Affiliation:
Pediatric Cardiology Service, Department of Cardiology “De'Gasperis”, Niguarda Hospital, Milan, Italy
Maurizio Lunati
Affiliation:
Electrophysiology Service, Department of Cardiology “De'Gasperis”, Niguarda Hospital, Milan, Italy
Alberto Figini
Affiliation:
Pediatric Cardiology Service, Department of Cardiology “De'Gasperis”, Niguarda Hospital, Milan, Italy
Get access Rights & Permissions [Opens in a new window]

Abstract

There is less certainty about the recommendations for radio-frequency ablation as a therapeutic option for Wolff-Parkinson-White syndrome in children as opposed to adults because of the different natural history and the age-related risks of ablation. To help decision-making, we evaluated the long term clinical evolution and electrophysiologic characteristics of pre-excitation in our series of children and young adults. We reviewed the clinical course of 109 patients below the age of 18 years who had been followed up over a period of 9+4 years, with a range from one to 27 years. This corresponded to 986 patient-years. We examined also the electrophysiologic data from 98 of those patients who underwent a transesophageal study.

At the discovery of pre-excitation, 59% of patients were asymptomatic, while 29% developed supraventricular tachycardia during follow-up. The peak incidence of the onset of supraventricular tachycardia occurred during infancy. These patients had the highest incidence of subsequent spontaneous disappearance of the tachycardia (53%), such a favourable evolution being encountered in only 12% of patients in whom the abnormal rhythm first appeared after 12 years of age. Chronic medical treatment was required in 47% of patients, and proved completely effective in 45% of cases. The potential to induce atrial fibrillation, and the incidence pre-excitation considered to be high risk, with the shortest pre-excited RR interval equal to or less than 220msec, was lowest in the group of patients aged less than 6 years of age, and highest in those older than 12 years of age (p <0.001). Pathways producing arrhythmia with high risk were more common in symptomatic (29%) than in asymptomatic patients (7%) (p<0.001). No mortality occurred. On the basis of our findings, we suggest that ablation should be avoided before the age of 5 or 6 years. Thereafter, the procedure should become the first line of treatment for symptomatic patients older than 12 years of age.

Keywords

Wolff-Parkinson-Whitepediatrics, evolutionabaltion
Type
Original Articles
Information
Cardiology in the Young , Volume 10 , Issue 4 , July 2000 , pp. 367 - 375
Copyright
Copyright © Cambridge University Press 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Borggrefe, M, Budde, T, Podczek, A, Breithardt, G.High frequency alternating current abalation of an accessory pathway in humans. J Am Coll Cardiol 1987; 10: 576–582.CrossRefGoogle Scholar
Park, JK, Halperin, BD, McAnulty, JH, Kron, J, Silka, MJ.Comparison,adolescents, and adukts and the impact of accessoty pathway location. Am L Cardiol 1994; 74, 786–789.CrossRefGoogle Scholar
VanHare, GF, Witherell, CL, Lesh, MD.Follow up of radiofrequency catherter ablation in children: results in 100 consecutive patients. J Am Coll Cardiol 1994;23: 1651–1659.CrossRefGoogle Scholar
Tanel, RE, Walsh, EP, Triedman, JK, Epstein, MR, Bergau, DM, Saul, JP. Five-year experience with radiofrequency catheterblation: implications for management of arrhythmias in pediatric and young adult patients.J pediatrics 1997; 131: 878–887.CrossRefGoogle ScholarPubMed
Kugler, JD. Radiofrequency catherer abaltion for supraventricular tachycardia. Should it be used in infdants and small children?Circulation 1994, 90: 639–641.Google Scholar
Erickson, CC, Walsh, EP, Saul, JP. Efficacy and safety of radiofrequency ablation in infants ans young children<18 months of age. Am J Cardiol 1994; 74: 944–947.CrossRefGoogle Scholar
Garson, A Jr, Kanter, RJ. Management of the child with Wolffparkinson-White syndrome and supraventricular tachycardia:model for cost-effectiveness. J Cardiovasc Electrophys 1997, 8: 1320–1326.CrossRefGoogle ScholarPubMed
Vignati, G, Mauri, L, Lunati, M, Gasparini, M, Figini, A. Transesophageal electrophysiological evauation of pediatric patients with Wolff-Parkinson-White syndrome. Eur Heart J 1992; 13: 220–222.CrossRefGoogle Scholar
Fitzpatrick, AP, Gonzales, RP, Lesh, MD, Modin, GU, Lee, RJ, Scheinman, MM. New algorithm for the localisation of accessory atrioventricular connections using a baseline electrocardiogram. J Am Coll Cardiol 1994; 23: 107–116.CrossRefGoogle ScholarPubMed
Wolff, L, Parkinson, J, White, PD. Bundle brqanch block with short PR interval in healthy youvg paople prone to paroxysmal tachycardia. Am Heart J 1930; 5: 685–704.CrossRefGoogle Scholar
Kugler, JD, Danford, DA.Management of infants,children,and adolescents with paroxysmal supraventricular tachycardia. J Pediatr 1996, 129: 324–338.CrossRefGoogle ScholarPubMed
Bromberg, BI, Lindsay, BD, Cain, ME, Cox, GL. Impact of clinical histroy and electrophysiologic characterisation of accessory pathways on manegement stratrgies to reduce sudden death among children with Wolff-Parkinson-White syndrome. J Am Coll Cardiol 1996; 27: 690–695.CrossRefGoogle Scholar
Munger, Tm, Packer, DL, Hammill, SC, Feldman, BJ, Bailey, KR, Ballard, DJ, Holmes, DR, Geish, BJ. A population study of the natural histroy of Wolff-Parkinson-Wolff syndrome in Olmsted Country, Minnesota, 1953–1989. Circulation 1993; 87: 866–873.CrossRefGoogle Scholar
Perry, JC, garson, A Jr. Supraventricular tachycardia due to Wolff-Parkinson-White sundrome in children: early disappearance and late recurrence. J Am Coll Cardiol 1990; 16: 1215–1220.CrossRefGoogle Scholar
Losekoot, TG, Lubbers, WLJ. The Wolff-Parkinson-white syndrome in childrome in childhood. Int J Cariol 1990; 27: 293–309.CrossRefGoogle ScholarPubMed
Swiderski, J, Lees, MH, Nadas, AS. Wolff-Parkinson-Whote syndrome in infancy and childhood. Br Heart J 1962; 24: 561–580.CrossRefGoogle ScholarPubMed
Deal, BJ, Keane, JF, Gillette, PC, Garson, A Jr. Wolff-Parkison-White syndrome and supraventricular tachycardia during infancy: management and follow-up. J Am Coll Cardiol 1985, 5: 130–135.CrossRefGoogle Scholar
Lundberg, A. Paroxysmal atrial tachycardia in infancy: long term follow-up study of 49 subjects. Pediatrics 1982; 70: 638–642.CrossRefGoogle ScholarPubMed
Klein, GJYee, R, Sharma, AD. Longitudial electrophysiologic assessment of asymptomatic patients with the Wolff-Parkinson-white electrocadiographic pattern. N Engl J Med 1989;320: 1229–1233.CrossRefGoogle Scholar
Chen, SA, Chiang, CE, Tai, CTLee, SH, Chiou, CW, Ueng, KC, Wen, ZC, Cheng, CC, Chang, MS. Longitudinal clinical and elctrophysiogical assessment of patients with symptomatic Wolff-Parkison-White syndrome qand atrioventricular node reentrant tachycardia. Circualtion 1996; 2023–2032.CrossRefGoogle Scholar
Krahsn, AD, Manfreda, J, Tate, RB, Mathewson, FA, Cuddy, TE. the natural histroy of electrocodiographic prexcitation in men. Ann Int Mrd 1992;116: 456–460.CrossRefGoogle Scholar
Chang, RKR, Glenn, MPH, Wetzel, GT, Stevenson, WG, Klintzer, Ts. Age-and anestesia-related changes in accessory pathway conduction in children with Wolff-Parkinson-White syndrome. Am J Cardiol 1995; 76: 1074–1076.CrossRefGoogle ScholarPubMed
Klein, GJ, Hackel, DB, Gallaher, JJ. anatomic substrate of imparied anterograde conduction over an accessotry AV pathway in the Wolff-Parkinson-White syndrome. Circulation 1986; 61: 1249–1256.CrossRefGoogle Scholar
Wolff, GS, Han, J, Curran, J. Wolff-Parkison-White syndrome in the neonate. Am J Cardiol 1978; 41: 559–563.CrossRefGoogle Scholar
Schoenfeld, MH. Pediatric pre-excitation: Say “no” to drugs? J Am Coll Cardiol 1990, 16: 1221–1223.CrossRefGoogle ScholarPubMed
Margolis, B, DeSilva, RA, Lown, B. Episodic drug treatment in the management of parxysmal arrhymias. Am J Cardiol. 1980: 621–626.CrossRefGoogle Scholar
Luedtke, SA, Kuhn, RJ, McCaffrey, M. Pharmacological management of supraventricular tachycardias in children. Part 1 Wolff-Parkinson-white and atrioventricular nodel reentry. Pediatrics 1997; 31: 1227–1243.Google ScholarPubMed
Benson, DW, Deal, BJ, Primary treatement of supraventricular tachycardia in infants and children. Progress in Pediatric Cardiology, 1995; 4: 109–214.CrossRefGoogle Scholar
Klein, GJ, Bashore, TM, Sellers, TD, Pritcher, EL, Smith, WH, Gallaher, JJ. Ventricular in the Wolff-Parkinson-White syndrome. N Engl J Med 1979; 301: 1080–1085.CrossRefGoogle ScholarPubMed
Sharma, AD, Yee, R, Guiraudon, G, Kelin, GJ. Sensitivity and specificity of invasive and noninvasive resting for risk of sudden death in Wolff-Parkinson-white syndrome. J Am Coll Cardiol 1987; 10: 373–381.CrossRefGoogle Scholar
Bromberge, BI, Lindasy, BD, Cain, ME, Coc, GL. Impact of clinical histroy and electrophysiologic characterison of accessory pathyways on management strategies to reduce sudden deah among children with Wolff-Parkinson-White syndrome. J Am J Coll Cardiol 1996; 27: 690–695.CrossRefGoogle Scholar
Drago, F, Turchetta, A, Calzolari, A, Guccione, P, Santilli, A, Pompei, E, Ragonese, P, galotio, FM. Detection of atrial vulnerability by Transesophagel atrial packing and relation of symptoms in children with Wolff-Parkinson-White syndrome. Am J Cardiol 1994; 74: 400–401.CrossRefGoogle Scholar
Allessie, MA, Reusma, PL, Brugada, J. Zipes, D, Jalife, J, editors. Pathophysiology of artial fibrilltion. In: Cardiac Electrophysiology. Form Cell to Beside. Philadelphia: WB saunders; 1990.p. 568–569.Google Scholar
Villan, E, Attali, T, Oserin, L, Aggon, Y, Kachaner, J. Outcome of Wolff-Parkinson-White syndrome in children. Transesophageal atudy of antegrade permeability of accessory pathway and atrial of antegrade permeability of accessory pathway and atrial vulnearability. Arch mal Coeur 1994; 87: 649–652.Google Scholar
Rinne, C, Klein, GJ, Shrma, AD, Yee, R, Milstein, S, Rattes, MF. Realation betrween clinical presentation and induced arrthythmial in the W-olff-Parksnion-White syndrome. Am J Cardiol 1987; 60: 579–579.CrossRefGoogle Scholar
Milstein, S, Sharma, AD, Klein, GJ. Electrophysiology profile of asymptomatic Wolff-Parkson-White pattern Am J Cardiol 1986; 57: 1097–1100.CrossRefGoogle ScholarPubMed
Kugler, JD, Danford, DA, Houston, K. Radiofrequency catheter ablation for paroxysmal supraventricular tachycardia in children and adolescents without structural heart disease. Am J Cardiol 1998, 80: 1438–1443.CrossRefGoogle Scholar
Kugler, JD, Danford, DA, Houston, K. Radiofrequency catheter ablation for parxysomal supraventricular tachycardia in children and adolescents without –487. structural heart diseace. Am J Cardiol 1994; 330: 1481–487.Google Scholar
Saul, JP, Papagianus, J, Van, Pragh R, Walsh, EP. Late enlargement of radiofrequency lesios in infant lambs: Implication for ablation procedures in small children. Circulation 1994; 90: 492–499.CrossRefGoogle Scholar
Paul, T, Bokenkamp, R, Mahnert, B, Bokenkamp, R. Coronary artery involvement early and late after radiofrequency current application in young pips. Am Heart J 1997; 133: 1436–1440.CrossRefGoogle Scholar