ABSTRACT
OBJECTIVES: There are very little data on pre-excitation syndrome (PS) in the elderly. We investigated the influence of advancing age on clinical presentation, treatment and long-term outcome of PS. SETTING: Single-centre retrospective study of patient files. PARTICIPANTS: In all, 961 patients (72 patients ≥60â years (mean 68.5±6), 889 patients <60â years (mean 30.5±14)) referred for overt pre-excitation and indication for electrophysiological study (EPS) were followed for 5.3±5â years. Usual care included 24â h Holter monitoring, echocardiography and EPS. Patients underwent accessory pathway (AP) ablation if necessary. PRIMARY AND SECONDARY OUTCOME MEASURES: Occurrence of atrial fibrillation (AF) or procedure-induced adverse event. RESULTS: Electrophysiological data and recourse to AP ablation (43% vs 48.5%, p=0.375) did not significantly differ between the groups. Older patients more often had symptomatic forms (81% vs 63%, p=0.003), history of spontaneous AF (8% vs 3%, p=0.01) or adverse presentation (poorly tolerated arrhythmias: 18% vs 7%, p=0.0009). In multivariable analysis, patients ≥60â years had a significantly higher risk of history of AF (OR=4.2, 2.1 to 8.3, p=0.001) and poorly tolerated arrhythmias (OR=3.8, 1.8 to 8.1, p=0.001). Age ≥60â years was associated with an increased major AP ablation complication risk (10% vs 1.9%, p=0.006). During follow-up, occurrence of AF (13.9% vs 3.6%, p<0.001) and incidence of poorly tolerated tachycardia (4.2% vs 0.6%, p=0.001) were more frequent in patients ≥60â years, although frequency of ablation failure or recurrence was similar (20% vs 15.5%, p=0.52). In multivariable analysis, patients ≥60â years had a significantly higher risk of AF (OR=2.9, 1.2 to 6.8, p≤0.01). CONCLUSIONS: In this retrospective monocentre study, patients ≥60â years referred for PS work up appeared at higher risk of AF and adverse presentation, both prior and after the work up. These results suggest that, in elderly patients, the decision for EPS and AP ablation should be discussed in light of their suspected higher risk of events and ablation complications. However, these findings should be further validated in future prospective multicentre studies.
Subject(s)
Atrial Fibrillation/diagnosis , Catheter Ablation/methods , Electrophysiologic Techniques, Cardiac/methods , Pre-Excitation Syndromes/diagnosis , Age Distribution , Aged , Aged, 80 and over , Atrial Fibrillation/epidemiology , Atrial Fibrillation/physiopathology , Atrial Fibrillation/therapy , Echocardiography , Electrocardiography , Electrocardiography, Ambulatory , Female , Follow-Up Studies , Humans , Incidence , Male , Middle Aged , Pre-Excitation Syndromes/epidemiology , Pre-Excitation Syndromes/physiopathology , Pre-Excitation Syndromes/therapy , Retrospective Studies , Risk Factors , United Kingdom/epidemiologySubject(s)
Aneurysm, Ruptured/etiology , Aortic Aneurysm, Abdominal/complications , Arteriovenous Fistula/etiology , Embolism, Paradoxical/etiology , Iliac Aneurysm/complications , Iliac Vein , Pulmonary Embolism/etiology , Aged , Aneurysm, Ruptured/diagnosis , Aneurysm, Ruptured/surgery , Aortic Aneurysm, Abdominal/diagnosis , Aortic Aneurysm, Abdominal/surgery , Arteriovenous Fistula/diagnosis , Arteriovenous Fistula/surgery , Blood Vessel Prosthesis Implantation , Embolism, Paradoxical/diagnosis , Embolism, Paradoxical/surgery , Humans , Iliac Aneurysm/diagnosis , Iliac Aneurysm/surgery , Iliac Vein/diagnostic imaging , Iliac Vein/surgery , Pulmonary Embolism/diagnosis , Pulmonary Embolism/surgery , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Aims Symptoms in children are often difficult to interpret. The purpose of this study was to report the results of transoesophageal electrophysiological study (EPS) performed in children complaining of sudden onset tachycardia with normal non-invasive studies. Methods and results Eighty-two children and teenagers (mean age 15 +/- 3 years) presented with suspected but no documented paroxysmal supraventricular tachycardia (SVT). ECG was normal. Non-invasive studies were negative; 23 children had syncope with tachycardias. They underwent transoesophageal EPS in our out-patient clinic. The mean duration of transoesophageal EPS was 11 +/- 5 min. Electrophysiological study was negative in 25 children. AV nodal re-entrant tachycardia could be induced in 37 children, 11 of them associated with syncope. Wolff-Parkinson-White syndrome (WPW) was diagnosed in five children in which atrioventricular re-entrant tachycardia was inducible. Atrioventricular re-entrant tachycardia due to a concealed AP was induced in 14 children. Verapamil-sensitive ventricular tachycardia was induced in one patient. Factors associated with tachycardia inducibility were an older age (15.5 +/- 2 vs. 14 +/- 4 years) (P < 0.05) and the absence of syncope (81 vs. 52%) (P < 0.05). During a mean follow-up of 3 +/- 1 year, no patient with negative EPS developed documented tachycardia. In 17 children with inducible SVT, radiofrequency ablation of the re-entrant circuit was subsequently performed. Conclusion Transoesophageal EPS is a fast method for proving the nature of paroxysmal tachycardia in children and teenagers presenting with normal ECG and for demonstrating WPW syndrome not visible on standard ECG. The negative predictive value of transoesophageal EPS for the diagnosis of SVT was 100%.