Analysis of clinical and electrophysiological characteristics of children with Wolff-Parkinson-White syndrome or ventricular pre-excitation / 中华实用儿科临床杂志

Objective@#To summarize the clinical and electrophysiological characteristics of children with Wolff-Parkinson-White syndrome or ventricular pre-excitation.@*Methods@#One hundred and seventy-nine consecutive children with Wolff-Parkinson-White syndrome or ventricular pre-excitation who were hospitalized at Beijing Anzhen Hospital Affiliated to Capital Medical University and planned to accept radiofrequency ablations were selected.Electrocardiogram and echocardiography were completed and detailed clinical data were collected before ablations.Anterograde refractory period of accessory pathways (ERPAPA) and retrograde ventriculoatrial conduction were measured during electrophysiology studies.The clinical and electrophysiological characteristics of these children were analyzed.@*Results@#The ratio of left-sided to right-sided accessory pathways was 1.001.93(61 cases vs.118 cases). Six out of 61 patients with left-sided accessory pathways were verified by electrophysiology study.There was no statistical difference of P-R interval and QRS duration between patients with right-sided and left-sided accessory pathways(all P>0.05). Twelve patients were combined with congenital heart diseases.Fourteen patients with right-sided accessory pathways were of ventricular pre-excitation induced dilated cardiomyopathy.ERPAPA was measured successfully in 110 patients, ERPAPA less than 250 ms accounted for 32.7%(36/110 cases). Six children with two pathways were recognized.Antidromic atrioventricular reentrant tachycardia was induced in 3 children.One child had slow conduction pathway localized in right-sided septum.@*Conclusions@#Right-sided overt accessory pathways are more common in children with Wolff-Parkinson-White syndrome or ventricular pre-excitation.Organic heart diseases are not uncommon.Besides congenital heart disease, a small proportion of patients with right overt accessory pathways may develop ventricular pre-excitatory induced dilated cardiomyopathy resulting from ventricular wall dyskinesia.Most of the decremental retrograde ventriculoatrial conduction is the characteristic of ventricular muscles rather than the accessory pathways in nature.Two pathways are not uncommon in children with Wolff-Parkinson-White syndrome or ventricular pre-excitation.Before finishing radiofrequency ablation, the anterograde and retrograde function of the accessory pathway should be evaluated in detail again because it is easy to neglect the existence of another accessory pathway.

La electrofisiología del Wolff-Parkinson-White en el paciente asintomático con actividad o riesgo profesional alto / The electrophysiology of Wolff-Parkinson-White in the asymptomatic patient with activity or with high professional risk

Objetivo: Describir las características electrofisiológicas en individuos con Wolff-Parkinson-White asintomático con actividad deportiva o alta responsabilidad profesional. Métodos: Se evaluaron 19 individuos, edad media 33 ± 13 años (grupo A). Las características electrofisiológicas fueron comparadas con un grupo control similar con WPW sintomático (grupo B). Resultados: En estado basal el periodo refractario anterógrado y la conducción anterógrada 1:1 sobre el fascículo accesorio fueron más largos en el grupo A (300 ± 48 ms vs 262 ± 32 ms, p < 0.05) y (355 ± 108 ms vs 307 ± 86 ms, p < 0.05), respectivamente. Ningún individuo del grupo A tuvo un periodo refractario anterógrado < 250 ms; y 58% no tuvieron conducción retrógrada sobre el fascículo accesorio vs 4% del grupo B (p< 0.001). La inducción de taquicardia fue significativamente menor (5.2%) en el grupo A vs grupo B (95%) (p < 0.001). Se indujo fibrilación auricular (FA) sólo en uno del grupo A vs en 32% grupo B (p< 0.001). Conclusión: Se confirman las características electrofisiológicas benignas en individuos asintomáticos comparados con sintomáticos. La deficiente conducción anterógrada junto con ausencia de conducción retrógrada explica la baja frecuencia de taquiarritmias y no apoyaría la investigación rutinaria en toda la población asintomática, pero debido a las posibles consecuencias, se mantiene la indicación sistemática con fines de ablación preventiva en el subgrupo de individuos asintomáticos con actividad deportiva o alta responsabilidad profesional.

Objective: Describe the electrophysiological characteristics in subjects with asymptomatic Wolff-Parkinson-White with sports activities or high professional responsibility. Methods: Nineteen subjects, mean age 33 ± 13 years (group A). The electrophysiological characteristics were compared with a matched group with symptomatic WPW (group B). Results: At baseline the anterograde refractory period and the anterograde conduction 1:1 over the accessory pathway were longer in group A (300 ± 48 ms vs 262 ± 32 ms, p <0.05 and 355 ± 108 ms vs 307 ± 86 ms, p <0.05), respectively. None of group A had a anterograde refractory period < 250 ms and 58% showed absence of retrograde conduction over the accessory pathway vs 4% of group B (p < 0.001). Induction of tachycardia was significantly less in group A (5%) than in group B (92%) (p < 0.001). Atrial fibrillation was induced in only one of group A vs 32% of group B (p< 0.001). Conclusion: We confirm the benign electrophysiological characteristics in asymptomatic compared to symptomatic subjects. Poor anterograde conduction along with absence of retrograde conduction explains the low frequency of tachyarrhythmias and would not support the routine investigation of all asymptomatic subjects. But, due to possible consequences, remains the systematic indication for preventive ablation in the subgroup of asymptomatic subjects with sporting activities or high professional responsibility.