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Impact of growth on electrophysiological properties of ventricular pre-excitation in paediatric athletes

Published online by Cambridge University Press:  21 November 2024

Cristina Raimondo ,
Francesco Flore ,
Antonino Maria Quintilio Alberio Open the ORCID record for Antonino Maria Quintilio Alberio [Opens in a new window] ,
Silvia Garibaldi ,
Marta Campisi ,
Ilaria Tamburri  and
Fabrizio Drago Open the ORCID record for Fabrizio Drago [Opens in a new window]
Cristina Raimondo
Affiliation:
Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
Francesco Flore
Affiliation:
Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
Antonino Maria Quintilio Alberio
Affiliation:
Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
Silvia Garibaldi
Affiliation:
Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
Marta Campisi
Affiliation:
Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
Ilaria Tamburri
Affiliation:
Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
Fabrizio Drago*
Affiliation:
Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
*
Corresponding author: Fabrizio Drago; Email: [email protected]
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Abstract

Aim:

Risk stratification is recommended for patients with ventricular pre-excitation, particularly when sports eligibility is required. Few studies have examined the changes in the electrophysiological properties of the accessory pathway during growth. This study investigates the evolution of electrophysiological properties of the ventricular pre-excitation in young athletes referred for sports eligibility.

Methods:

Between January 2011 and July 2022, 44 paediatric patients (32 males; mean age, 10 ± 2.42) with ventricular pre-excitation underwent an electrophysiological study, both at rest and during adrenergic stress at two different times (T0 and T1) within a minimal interval of 2 years. Transcatheter ablation was not performed between the two electrophysiological studies. Electrophysiological data were collected and compared.

Results:

Electrophysiological study under basal conditions showed a significant decrease in the anterograde accessory pathway effective refractory period and 1:1 conduction over the accessory pathway from T0 to T1. The shortest pre-excited R-R interval during atrial fibrillation did not significantly change at the basal condition; however, it decreased during the stress test. Furthermore, six patients (13.6%) changed the risk profile of their accessory pathway: two “high-risk” patients at T0 became “low-risk” and four “low-risk” patients became “high-risk” at T1. Atrioventricular re-entry tachycardia inducibility did not differ significantly between the two electrophysiological studies.

Conclusions:

This study highlights the importance of repeating electrophysiological study (transesophageal or intracardiac) in paediatric athletes with ventricular pre-excitation because significant and clinically relevant changes in the conduction and refractoriness of accessory pathway can occur. This could influence risk stratification for sports eligibility and the correct indication and timing for accessory pathway ablation.

Keywords

paediatricspre-excitation syndromeselectrophysiologic techniquestransesophageal electrophysiological studypreventive medicine
Type
Original Article
Information
Cardiology in the Young , Volume 35 , Issue 2 , February 2025 , pp. 261 - 266
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Copyright
© The Author(s), 2024. Published by Cambridge University Press

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