Risk Factors for Atrioventricular Tachycardia Degenerating to Atrial Flutter/Fibrillation in the Young with Wolff‐Parkinson‐White
Identifieur interne : 000101 ( Main/Corpus ); précédent : 000100; suivant : 000102Risk Factors for Atrioventricular Tachycardia Degenerating to Atrial Flutter/Fibrillation in the Young with Wolff‐Parkinson‐White
Auteurs : Ashraf Harahsheh ; Wei Du ; Harinder Singh ; Peter P. KarpawichSource :
- Pacing and Clinical Electrophysiology [ 0147-8389 ] ; 2008-10.
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- KwdEn :
Abstract
Background: Atrioventricular reciprocating tachycardia (AVRT) is common in patients (pts) with Wolff‐Parkinson‐White (WPW) syndrome but atrial flutter/fibrillation (AF) with rapid ventricular response (RVR) is rare. Although AF occurs in 18% of adult WPW pts, its incidence in children is unknown. We sought to determine risk factors for AVRT spontaneously degenerating to AF during electrophysiologic studies (EPS) in children with WPW. Methods: This was a retrospective study of children with WPW referred for accessory pathway (AP) ablation without clinical AF. Standard electrophysiologic protocols were performed to induce AVRT. To determine if AF degeneration was associated with patient characteristics, 2‐sample t‐tests, Chi‐square, and Fisher's exact were used. Results: There were 53 (31 males) WPW pts studied. During EPS, AVRT degenerated to AF in 27/53 (51%). RVR was seen in 18/27 (67%) patients. The ventricular cycle length (CL) during AF was shorter with RVR (211 + 24 ms) than without (313 + 65 ms) (P = 0.01). AF occurred more commonly among patients with right anterior AP (P = 0.05). Patient gender, age, height, weight, body surface area, persistence of preexcitation on exercise testing, baseline CL, AVRT conduction, and AP number were not significant AF determinants. The AVRT CL was significantly shorter in patients with (265.2 + 41.5 ms) versus those without (308 + 59 ms) AF (P = 0.01). Preliminary data suggest that AP location may be related to patient ethnicity. Conclusion: AF with RVR occurred following AVRT induction during EPS in 34% of our WPW patients, typically associated with right‐sided AP locations. Time intervals for RVR to degenerate into ventricular fibrillation and lead to SCD are yet to be determined.
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DOI: 10.1111/j.1540-8159.2008.01182.x
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Risk Factors for Atrioventricular Tachycardia Degenerating to Atrial Flutter/Fibrillation in the Young with Wolff‐Parkinson‐White</title><author><name sortKey="Harahsheh, Ashraf" sort="Harahsheh, Ashraf" uniqKey="Harahsheh A" first="Ashraf" last="Harahsheh">Ashraf Harahsheh</name><affiliation><mods:affiliation>Section of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan</mods:affiliation></affiliation></author><author><name sortKey="Du, Wei" sort="Du, Wei" uniqKey="Du W" first="Wei" last="Du">Wei Du</name><affiliation><mods:affiliation>Section of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan</mods:affiliation></affiliation></author><author><name sortKey="Singh, Harinder" sort="Singh, Harinder" uniqKey="Singh H" first="Harinder" last="Singh">Harinder Singh</name><affiliation><mods:affiliation>Section of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan</mods:affiliation></affiliation></author><author><name sortKey="Karpawich, Peter P" sort="Karpawich, Peter P" uniqKey="Karpawich P" first="Peter P." last="Karpawich">Peter P. Karpawich</name><affiliation><mods:affiliation>Section of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:804CE97EDAE755BFFB9FFF671BB83AC76B9E601E</idno><date when="2008" year="2008">2008</date><idno type="doi">10.1111/j.1540-8159.2008.01182.x</idno><idno type="url">https://api.istex.fr/document/804CE97EDAE755BFFB9FFF671BB83AC76B9E601E/fulltext/pdf</idno><idno type="wicri:Area/Main/Corpus">000101</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Risk Factors for Atrioventricular Tachycardia Degenerating to Atrial Flutter/Fibrillation in the Young with Wolff‐Parkinson‐White</title><author><name sortKey="Harahsheh, Ashraf" sort="Harahsheh, Ashraf" uniqKey="Harahsheh A" first="Ashraf" last="Harahsheh">Ashraf Harahsheh</name><affiliation><mods:affiliation>Section of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan</mods:affiliation></affiliation></author><author><name sortKey="Du, Wei" sort="Du, Wei" uniqKey="Du W" first="Wei" last="Du">Wei Du</name><affiliation><mods:affiliation>Section of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan</mods:affiliation></affiliation></author><author><name sortKey="Singh, Harinder" sort="Singh, Harinder" uniqKey="Singh H" first="Harinder" last="Singh">Harinder Singh</name><affiliation><mods:affiliation>Section of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan</mods:affiliation></affiliation></author><author><name sortKey="Karpawich, Peter P" sort="Karpawich, Peter P" uniqKey="Karpawich P" first="Peter P." last="Karpawich">Peter P. Karpawich</name><affiliation><mods:affiliation>Section of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Pacing and Clinical Electrophysiology</title><idno type="ISSN">0147-8389</idno><idno type="eISSN">1540-8159</idno><imprint><publisher>Blackwell Publishing Inc</publisher><pubPlace>Malden, USA</pubPlace><date type="published" when="2008-10">2008-10</date><biblScope unit="volume">31</biblScope><biblScope unit="issue">10</biblScope><biblScope unit="page" from="1307">1307</biblScope><biblScope unit="page" to="1312">1312</biblScope></imprint><idno type="ISSN">0147-8389</idno></series><idno type="istex">804CE97EDAE755BFFB9FFF671BB83AC76B9E601E</idno><idno type="DOI">10.1111/j.1540-8159.2008.01182.x</idno><idno type="ArticleID">PACE1182</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0147-8389</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Wolff‐Parkinson‐White</term><term>atrial flutter</term><term>demographics</term><term>pediatrics</term><term>supraventricular tachycardia</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background: Atrioventricular reciprocating tachycardia (AVRT) is common in patients (pts) with Wolff‐Parkinson‐White (WPW) syndrome but atrial flutter/fibrillation (AF) with rapid ventricular response (RVR) is rare. Although AF occurs in 18% of adult WPW pts, its incidence in children is unknown. We sought to determine risk factors for AVRT spontaneously degenerating to AF during electrophysiologic studies (EPS) in children with WPW. Methods: This was a retrospective study of children with WPW referred for accessory pathway (AP) ablation without clinical AF. Standard electrophysiologic protocols were performed to induce AVRT. To determine if AF degeneration was associated with patient characteristics, 2‐sample t‐tests, Chi‐square, and Fisher's exact were used. Results: There were 53 (31 males) WPW pts studied. During EPS, AVRT degenerated to AF in 27/53 (51%). RVR was seen in 18/27 (67%) patients. The ventricular cycle length (CL) during AF was shorter with RVR (211 + 24 ms) than without (313 + 65 ms) (P = 0.01). AF occurred more commonly among patients with right anterior AP (P = 0.05). Patient gender, age, height, weight, body surface area, persistence of preexcitation on exercise testing, baseline CL, AVRT conduction, and AP number were not significant AF determinants. The AVRT CL was significantly shorter in patients with (265.2 + 41.5 ms) versus those without (308 + 59 ms) AF (P = 0.01). Preliminary data suggest that AP location may be related to patient ethnicity. Conclusion: AF with RVR occurred following AVRT induction during EPS in 34% of our WPW patients, typically associated with right‐sided AP locations. Time intervals for RVR to degenerate into ventricular fibrillation and lead to SCD are yet to be determined.</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>ASHRAF HARAHSHEH M.D.</name><affiliations><json:string>Section of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan</json:string></affiliations></json:item><json:item><name>WEI DU Ph.D.</name><affiliations><json:string>Section of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan</json:string></affiliations></json:item><json:item><name>HARINDER SINGH M.D.</name><affiliations><json:string>Section of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan</json:string></affiliations></json:item><json:item><name>PETER P. KARPAWICH M.D.</name><affiliations><json:string>Section of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>atrial flutter</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Wolff‐Parkinson‐White</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>supraventricular tachycardia</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>pediatrics</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>demographics</value></json:item></subject><articleId><json:string>PACE1182</json:string></articleId><language><json:string>eng</json:string></language><abstract>Background: Atrioventricular reciprocating tachycardia (AVRT) is common in patients (pts) with Wolff‐Parkinson‐White (WPW) syndrome but atrial flutter/fibrillation (AF) with rapid ventricular response (RVR) is rare. Although AF occurs in 18% of adult WPW pts, its incidence in children is unknown. We sought to determine risk factors for AVRT spontaneously degenerating to AF during electrophysiologic studies (EPS) in children with WPW. Methods: This was a retrospective study of children with WPW referred for accessory pathway (AP) ablation without clinical AF. Standard electrophysiologic protocols were performed to induce AVRT. To determine if AF degeneration was associated with patient characteristics, 2‐sample t‐tests, Chi‐square, and Fisher's exact were used. Results: There were 53 (31 males) WPW pts studied. During EPS, AVRT degenerated to AF in 27/53 (51%). RVR was seen in 18/27 (67%) patients. The ventricular cycle length (CL) during AF was shorter with RVR (211 + 24 ms) than without (313 + 65 ms) (P = 0.01). AF occurred more commonly among patients with right anterior AP (P = 0.05). Patient gender, age, height, weight, body surface area, persistence of preexcitation on exercise testing, baseline CL, AVRT conduction, and AP number were not significant AF determinants. The AVRT CL was significantly shorter in patients with (265.2 + 41.5 ms) versus those without (308 + 59 ms) AF (P = 0.01). Preliminary data suggest that AP location may be related to patient ethnicity. Conclusion: AF with RVR occurred following AVRT induction during EPS in 34% of our WPW patients, typically associated with right‐sided AP locations. Time intervals for RVR to degenerate into ventricular fibrillation and lead to SCD are yet to be determined.</abstract><qualityIndicators><score>7.799</score><pdfVersion>1.4</pdfVersion><pdfPageSize>594 x 784 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>5</keywordCount><abstractCharCount>1752</abstractCharCount><pdfWordCount>4299</pdfWordCount><pdfCharCount>27118</pdfCharCount><pdfPageCount>6</pdfPageCount><abstractWordCount>269</abstractWordCount></qualityIndicators><title>Risk Factors for Atrioventricular Tachycardia Degenerating to Atrial Flutter/Fibrillation in the Young with Wolff‐Parkinson‐White</title><genre><json:string>article</json:string></genre><host><volume>31</volume><publisherId><json:string>PACE</json:string></publisherId><pages><total>6</total><last>1312</last><first>1307</first></pages><issn><json:string>0147-8389</json:string></issn><issue>10</issue><genre><json:string>Journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1540-8159</json:string></eissn><title>Pacing and Clinical Electrophysiology</title><doi><json:string>10.1111/(ISSN)1540-8159</json:string></doi></host><publicationDate>2008</publicationDate><copyrightDate>2008</copyrightDate><doi><json:string>10.1111/j.1540-8159.2008.01182.x</json:string></doi><id>804CE97EDAE755BFFB9FFF671BB83AC76B9E601E</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/804CE97EDAE755BFFB9FFF671BB83AC76B9E601E/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/804CE97EDAE755BFFB9FFF671BB83AC76B9E601E/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/804CE97EDAE755BFFB9FFF671BB83AC76B9E601E/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Risk Factors for Atrioventricular Tachycardia Degenerating to Atrial Flutter/Fibrillation in the Young with Wolff‐Parkinson‐White</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Blackwell Publishing Inc</publisher><pubPlace>Malden, USA</pubPlace><availability><p>WILEY</p></availability><date>2008</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Risk Factors for Atrioventricular Tachycardia Degenerating to Atrial Flutter/Fibrillation in the Young with Wolff‐Parkinson‐White</title><author><persName><forename type="first">ASHRAF</forename><surname>HARAHSHEH</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Section of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan</affiliation></author><author><persName><forename type="first">WEI</forename><surname>DU</surname></persName><roleName type="degree">Ph.D.</roleName><affiliation>Section of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan</affiliation></author><author><persName><forename type="first">HARINDER</forename><surname>SINGH</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Section of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan</affiliation></author><author><persName><forename type="first">PETER P.</forename><surname>KARPAWICH</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Section of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan</affiliation></author></analytic><monogr><title level="j">Pacing and Clinical Electrophysiology</title><idno type="pISSN">0147-8389</idno><idno type="eISSN">1540-8159</idno><idno type="DOI">10.1111/(ISSN)1540-8159</idno><imprint><publisher>Blackwell Publishing Inc</publisher><pubPlace>Malden, USA</pubPlace><date type="published" when="2008-10"></date><biblScope unit="volume">31</biblScope><biblScope unit="issue">10</biblScope><biblScope unit="page" from="1307">1307</biblScope><biblScope unit="page" to="1312">1312</biblScope></imprint></monogr><idno type="istex">804CE97EDAE755BFFB9FFF671BB83AC76B9E601E</idno><idno type="DOI">10.1111/j.1540-8159.2008.01182.x</idno><idno type="ArticleID">PACE1182</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2008</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Background: Atrioventricular reciprocating tachycardia (AVRT) is common in patients (pts) with Wolff‐Parkinson‐White (WPW) syndrome but atrial flutter/fibrillation (AF) with rapid ventricular response (RVR) is rare. Although AF occurs in 18% of adult WPW pts, its incidence in children is unknown. We sought to determine risk factors for AVRT spontaneously degenerating to AF during electrophysiologic studies (EPS) in children with WPW. Methods: This was a retrospective study of children with WPW referred for accessory pathway (AP) ablation without clinical AF. Standard electrophysiologic protocols were performed to induce AVRT. To determine if AF degeneration was associated with patient characteristics, 2‐sample t‐tests, Chi‐square, and Fisher's exact were used. Results: There were 53 (31 males) WPW pts studied. During EPS, AVRT degenerated to AF in 27/53 (51%). RVR was seen in 18/27 (67%) patients. The ventricular cycle length (CL) during AF was shorter with RVR (211 + 24 ms) than without (313 + 65 ms) (P = 0.01). AF occurred more commonly among patients with right anterior AP (P = 0.05). Patient gender, age, height, weight, body surface area, persistence of preexcitation on exercise testing, baseline CL, AVRT conduction, and AP number were not significant AF determinants. The AVRT CL was significantly shorter in patients with (265.2 + 41.5 ms) versus those without (308 + 59 ms) AF (P = 0.01). Preliminary data suggest that AP location may be related to patient ethnicity. Conclusion: AF with RVR occurred following AVRT induction during EPS in 34% of our WPW patients, typically associated with right‐sided AP locations. Time intervals for RVR to degenerate into ventricular fibrillation and lead to SCD are yet to be determined.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>atrial flutter</term></item><item><term>Wolff‐Parkinson‐White</term></item><item><term>supraventricular tachycardia</term></item><item><term>pediatrics</term></item><item><term>demographics</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2008-10">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/804CE97EDAE755BFFB9FFF671BB83AC76B9E601E/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Blackwell Publishing Inc</publisherName><publisherLoc>Malden, USA</publisherLoc></publisherInfo><doi origin="wiley" registered="yes">10.1111/(ISSN)1540-8159</doi><issn type="print">0147-8389</issn><issn type="electronic">1540-8159</issn><idGroup><id type="product" value="PACE"></id><id type="publisherDivision" value="ST"></id></idGroup><titleGroup><title type="main" sort="PACING CLINICAL ELECTROPHYSIOLOGY">Pacing and Clinical Electrophysiology</title></titleGroup></publicationMeta><publicationMeta level="part" position="10010"><doi origin="wiley">10.1111/pace.2008.31.issue-10</doi><numberingGroup><numbering type="journalVolume" number="31">31</numbering><numbering type="journalIssue" number="10">10</numbering></numberingGroup><coverDate startDate="2008-10">October 2008</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="13" status="forIssue"><doi origin="wiley">10.1111/j.1540-8159.2008.01182.x</doi><idGroup><id type="unit" value="PACE1182"></id></idGroup><countGroup><count type="pageTotal" number="6"></count></countGroup><titleGroup><title type="tocHeading1"><i>ORIGINAL ARTICLES</i></title></titleGroup><copyright>©2008, The Authors. Journal compilation ©2008, Blackwell Publishing, Inc.</copyright><eventGroup><event type="firstOnline" date="2008-09-15"></event><event type="publishedOnlineFinalForm" date="2008-09-15"></event><event type="xmlConverted" agent="Converter:BPG_TO_WML3G version:2.3.5 mode:FullText source:FullText result:FullText" date="2010-04-07"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-02-06"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-11-03"></event></eventGroup><numberingGroup><numbering type="pageFirst" number="1307">1307</numbering><numbering type="pageLast" number="1312">1312</numbering></numberingGroup><correspondenceTo>Address for reprints: Peter P. Karpawich, M.D., Director, Cardiac Electrophysiology, Children's Hospital of Michigan, 3901 Beaubien Boulevard, Detroit, MI, 48201. Fax: 313‐993‐0894; e‐mail: <email>pkarpawi@dmc.org</email></correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:PACE.PACE1182.pdf"></link></linkGroup></publicationMeta><contentMeta><unparsedEditorialHistory>Received April 8, 2008; revised June 5, 2008; accepted June 27, 2008.</unparsedEditorialHistory><countGroup><count type="figureTotal" number="0"></count><count type="tableTotal" number="3"></count><count type="formulaTotal" number="0"></count><count type="referenceTotal" number="24"></count><count type="linksCrossRef" number="57"></count></countGroup><titleGroup><title type="main">Risk Factors for Atrioventricular Tachycardia Degenerating to Atrial Flutter/Fibrillation in the Young with Wolff‐Parkinson‐White</title><title type="shortAuthors">HARAHSHEH, ET AL.</title><title type="short">ATRIAL FLUTTER IN CHILDREN WITH WPW</title></titleGroup><creators><creator creatorRole="author" xml:id="cr1" affiliationRef="#a1"><personName><givenNames>ASHRAF</givenNames><familyName>HARAHSHEH</familyName><degrees>M.D.</degrees></personName></creator><creator creatorRole="author" xml:id="cr2" affiliationRef="#a1"><personName><givenNames>WEI</givenNames><familyName>DU</familyName><degrees>Ph.D.</degrees></personName></creator><creator creatorRole="author" xml:id="cr3" affiliationRef="#a1"><personName><givenNames>HARINDER</givenNames><familyName>SINGH</familyName><degrees>M.D.</degrees></personName></creator><creator creatorRole="author" xml:id="cr4" affiliationRef="#a1"><personName><givenNames>PETER P.</givenNames><familyName>KARPAWICH</familyName><degrees>M.D.</degrees></personName></creator></creators><affiliationGroup><affiliation xml:id="a1" countryCode="US"><unparsedAffiliation>Section of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en"><keyword xml:id="k1"><i>atrial flutter</i></keyword><keyword xml:id="k2"><i>Wolff‐Parkinson‐White</i></keyword><keyword xml:id="k3"><i>supraventricular tachycardia</i></keyword><keyword xml:id="k4"><i>pediatrics</i></keyword><keyword xml:id="k5"><i>demographics</i></keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><p> <b><i>Background:</i></b><i>Atrioventricular reciprocating tachycardia (AVRT) is common in patients (pts) with Wolff‐Parkinson‐White (WPW) syndrome but atrial flutter/fibrillation (AF) with rapid ventricular response (RVR) is rare. Although AF occurs in 18% of adult WPW pts, its incidence in children is unknown. We sought to determine risk factors for AVRT spontaneously degenerating to AF during electrophysiologic studies (EPS) in children with WPW.</i> </p><p> <b><i>Methods:</i></b><i>This was a retrospective study of children with WPW referred for accessory pathway (AP) ablation without clinical AF. Standard electrophysiologic protocols were performed to induce AVRT. To determine if AF degeneration was associated with patient characteristics, 2‐sample</i> t<i>‐tests, Chi‐square, and Fisher's exact were used.</i></p><p> <b><i>Results:</i></b><i>There were 53 (31 males) WPW pts studied. During EPS, AVRT degenerated to AF in 27/53 (51%). RVR was seen in 18/27 (67%) patients. The ventricular cycle length (CL) during AF was shorter with RVR (211 + 24 ms) than without (313 + 65 ms) (P = 0.01). AF occurred more commonly among patients with right anterior AP (P = 0.05). Patient gender, age, height, weight, body surface area, persistence of preexcitation on exercise testing, baseline CL, AVRT conduction, and AP number were not significant AF determinants. The AVRT CL was significantly shorter in patients with (265.2 + 41.5 ms) versus those without (308 + 59 ms) AF (P = 0.01). Preliminary data suggest that AP location may be related to patient ethnicity.</i> </p><p> <b><i>Conclusion:</i></b><i>AF with RVR occurred following AVRT induction during EPS in 34% of our WPW patients, typically associated with right‐sided AP locations. Time intervals for RVR to degenerate into ventricular fibrillation and lead to SCD are yet to be determined.</i> </p><!-- (PACE 2008; 31:1307–1312)
</abstractGroup></contentMeta><noteGroup><note xml:id="n-fnt-1" numbered="no"><p>Conflict of interest and financial disclosure: none</p></note></noteGroup></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Risk Factors for Atrioventricular Tachycardia Degenerating to Atrial Flutter/Fibrillation in the Young with Wolff‐Parkinson‐White</title></titleInfo><titleInfo type="abbreviated"><title>ATRIAL FLUTTER IN CHILDREN WITH WPW</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Risk Factors for Atrioventricular Tachycardia Degenerating to Atrial Flutter/Fibrillation in the Young with Wolff‐Parkinson‐White</title></titleInfo><name type="personal"><namePart type="given">ASHRAF</namePart><namePart type="family">HARAHSHEH</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Section of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">WEI</namePart><namePart type="family">DU</namePart><namePart type="termsOfAddress">Ph.D.</namePart><affiliation>Section of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">HARINDER</namePart><namePart type="family">SINGH</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Section of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">PETER P.</namePart><namePart type="family">KARPAWICH</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Section of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Blackwell Publishing Inc</publisher><place><placeTerm type="text">Malden, USA</placeTerm></place><dateIssued encoding="w3cdtf">2008-10</dateIssued><edition>Received April 8, 2008; revised June 5, 2008; accepted June 27, 2008.</edition><copyrightDate encoding="w3cdtf">2008</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="tables">3</extent><extent unit="references">24</extent></physicalDescription><abstract lang="en">Background: Atrioventricular reciprocating tachycardia (AVRT) is common in patients (pts) with Wolff‐Parkinson‐White (WPW) syndrome but atrial flutter/fibrillation (AF) with rapid ventricular response (RVR) is rare. Although AF occurs in 18% of adult WPW pts, its incidence in children is unknown. We sought to determine risk factors for AVRT spontaneously degenerating to AF during electrophysiologic studies (EPS) in children with WPW. Methods: This was a retrospective study of children with WPW referred for accessory pathway (AP) ablation without clinical AF. Standard electrophysiologic protocols were performed to induce AVRT. To determine if AF degeneration was associated with patient characteristics, 2‐sample t‐tests, Chi‐square, and Fisher's exact were used. Results: There were 53 (31 males) WPW pts studied. During EPS, AVRT degenerated to AF in 27/53 (51%). RVR was seen in 18/27 (67%) patients. The ventricular cycle length (CL) during AF was shorter with RVR (211 + 24 ms) than without (313 + 65 ms) (P = 0.01). AF occurred more commonly among patients with right anterior AP (P = 0.05). Patient gender, age, height, weight, body surface area, persistence of preexcitation on exercise testing, baseline CL, AVRT conduction, and AP number were not significant AF determinants. The AVRT CL was significantly shorter in patients with (265.2 + 41.5 ms) versus those without (308 + 59 ms) AF (P = 0.01). Preliminary data suggest that AP location may be related to patient ethnicity. Conclusion: AF with RVR occurred following AVRT induction during EPS in 34% of our WPW patients, typically associated with right‐sided AP locations. Time intervals for RVR to degenerate into ventricular fibrillation and lead to SCD are yet to be determined.</abstract><subject lang="en"><genre>Keywords</genre><topic>atrial flutter</topic><topic>Wolff‐Parkinson‐White</topic><topic>supraventricular tachycardia</topic><topic>pediatrics</topic><topic>demographics</topic></subject><relatedItem type="host"><titleInfo><title>Pacing and Clinical Electrophysiology</title></titleInfo><genre type="Journal">journal</genre><identifier type="ISSN">0147-8389</identifier><identifier type="eISSN">1540-8159</identifier><identifier type="DOI">10.1111/(ISSN)1540-8159</identifier><identifier type="PublisherID">PACE</identifier><part><date>2008</date><detail type="volume"><caption>vol.</caption><number>31</number></detail><detail type="issue"><caption>no.</caption><number>10</number></detail><extent unit="pages"><start>1307</start><end>1312</end><total>6</total></extent></part></relatedItem><identifier type="istex">804CE97EDAE755BFFB9FFF671BB83AC76B9E601E</identifier><identifier type="DOI">10.1111/j.1540-8159.2008.01182.x</identifier><identifier type="ArticleID">PACE1182</identifier><accessCondition type="use and reproduction" contentType="copyright">©2008, The Authors. 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