Impact of clinical history and electrophysiologic characterization of accessory pathways on management strategies to reduce sudden death among children with Wolff-Parkinson-White syndrome
Identifieur interne : 000186 ( Main/Corpus ); précédent : 000185; suivant : 000187Impact of clinical history and electrophysiologic characterization of accessory pathways on management strategies to reduce sudden death among children with Wolff-Parkinson-White syndrome
Auteurs : Burt I. Bromberg ; Bruce D. Lindsay ; Michael E. Cain ; James L. CoxSource :
- Journal of the American College of Cardiology [ 0735-1097 ] ; 1995.
Abstract
Objectives. This study sought to determine whether the clinical and electrophysiologic criteria developed in adults also identify children with Wolff-Parkinson-White syndrome at risk for sudden death.Background. In adults with Wolff-Parkinson-White syndrome, a shortest RR interval <220 ms during atrial fibrillation is a sensitive marker for sudden death. However, because reliance on the shortest RR interval has a low positive predictive value, the clinical history has assumed a pivotal role in assessing risk. This approach has not been evaluated in children.Methods. We retrospectively evaluated 60 children ≤18 years old who underwent comprehensive electrophysiologic evaluation between 1979 and 1989 before undergoing operation for Wolff-Parkinson-White syndrome. Clinical and electrophysiologic data were analyzed after patients had been grouped by ther clinical presentation: high risk (cardiac arrest), intermediate risk (syncope or atrial fibrillation) or low risk (orthodromic reciprocating tachycardia alone).Results. Ten children had a clinical cardiac arrest (high risk); only one had a prior history of syncope or atrial fibrillation. Compared with the intermediate (n = 19) and low risk groups (n = 31), there were no differences in age ([mean ± SD] 14.8 ± 0.6 vs. 14.7 ± 0.6 vs. 14.5 ± 1.7 years), duration of symptoms (1.9 ± 0.5 vs. 4.1 ± 1.1 vs. 5.2 ± 0.8 years), incidence of congenital heart disease (30% vs. 26% vs. 32%), presence of multiple pathways (20% vs. 16% vs. 16%) or accessory pathway location. A shortest pre-excited RR interval <220 ms was found in 7 of 7 high risk patients (sensitivity 100%), 14 of 19 intermediate risk patients and 11 of 31 low risk patients (prevalence 35%).Conclusions. Cardiac arrest was the only distinguishing clinical feature between high and low risk groups and the first manifestation in 80% of the children of an accessory pathway that can precipitate a life-threatening arrhythmia. In this series, the largest reported to date of children with Wolff-Parkinson-White syndrome having a cardiac arrest, a shortest pre-excited RR interval <220 ms was more sensitive than clinical history for identifying those at risk for sudden death.
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DOI: 10.1016/0735-1097(95)00519-6
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Impact of clinical history and electrophysiologic characterization of accessory pathways on management strategies to reduce sudden death among children with Wolff-Parkinson-White syndrome</title><author><name sortKey="Bromberg, Burt I" sort="Bromberg, Burt I" uniqKey="Bromberg B" first="Burt I." last="Bromberg">Burt I. Bromberg</name><affiliation><mods:affiliation>Department of Pediatrics, Cardiovascular Division of Internal Medicine and Division of Cardiovascular Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA</mods:affiliation></affiliation></author><author><name sortKey="Lindsay, Bruce D" sort="Lindsay, Bruce D" uniqKey="Lindsay B" first="Bruce D." last="Lindsay">Bruce D. Lindsay</name><affiliation><mods:affiliation>Department of Pediatrics, Cardiovascular Division of Internal Medicine and Division of Cardiovascular Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA</mods:affiliation></affiliation></author><author><name sortKey="Cain, Michael E" sort="Cain, Michael E" uniqKey="Cain M" first="Michael E." last="Cain">Michael E. Cain</name><affiliation><mods:affiliation>Department of Pediatrics, Cardiovascular Division of Internal Medicine and Division of Cardiovascular Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA</mods:affiliation></affiliation></author><author><name sortKey="Cox, James L" sort="Cox, James L" uniqKey="Cox J" first="James L." last="Cox">James L. Cox</name><affiliation><mods:affiliation>Department of Pediatrics, Cardiovascular Division of Internal Medicine and Division of Cardiovascular Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:B98C2EA910E7B8D9F2D1BC59FE445006AF2B582E</idno><date when="1996" year="1996">1996</date><idno type="doi">10.1016/0735-1097(95)00519-6</idno><idno type="url">https://api.istex.fr/document/B98C2EA910E7B8D9F2D1BC59FE445006AF2B582E/fulltext/pdf</idno><idno type="wicri:Area/Main/Corpus">000186</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Impact of clinical history and electrophysiologic characterization of accessory pathways on management strategies to reduce sudden death among children with Wolff-Parkinson-White syndrome</title><author><name sortKey="Bromberg, Burt I" sort="Bromberg, Burt I" uniqKey="Bromberg B" first="Burt I." last="Bromberg">Burt I. Bromberg</name><affiliation><mods:affiliation>Department of Pediatrics, Cardiovascular Division of Internal Medicine and Division of Cardiovascular Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA</mods:affiliation></affiliation></author><author><name sortKey="Lindsay, Bruce D" sort="Lindsay, Bruce D" uniqKey="Lindsay B" first="Bruce D." last="Lindsay">Bruce D. Lindsay</name><affiliation><mods:affiliation>Department of Pediatrics, Cardiovascular Division of Internal Medicine and Division of Cardiovascular Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA</mods:affiliation></affiliation></author><author><name sortKey="Cain, Michael E" sort="Cain, Michael E" uniqKey="Cain M" first="Michael E." last="Cain">Michael E. Cain</name><affiliation><mods:affiliation>Department of Pediatrics, Cardiovascular Division of Internal Medicine and Division of Cardiovascular Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA</mods:affiliation></affiliation></author><author><name sortKey="Cox, James L" sort="Cox, James L" uniqKey="Cox J" first="James L." last="Cox">James L. Cox</name><affiliation><mods:affiliation>Department of Pediatrics, Cardiovascular Division of Internal Medicine and Division of Cardiovascular Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of the American College of Cardiology</title><title level="j" type="abbrev">JAC</title><idno type="ISSN">0735-1097</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1995">1995</date><biblScope unit="volume">27</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="690">690</biblScope><biblScope unit="page" to="695">695</biblScope></imprint><idno type="ISSN">0735-1097</idno></series><idno type="istex">B98C2EA910E7B8D9F2D1BC59FE445006AF2B582E</idno><idno type="DOI">10.1016/0735-1097(95)00519-6</idno><idno type="PII">0735-1097(95)00519-6</idno><idno type="ArticleID">95005196</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0735-1097</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objectives. This study sought to determine whether the clinical and electrophysiologic criteria developed in adults also identify children with Wolff-Parkinson-White syndrome at risk for sudden death.Background. In adults with Wolff-Parkinson-White syndrome, a shortest RR interval <220 ms during atrial fibrillation is a sensitive marker for sudden death. However, because reliance on the shortest RR interval has a low positive predictive value, the clinical history has assumed a pivotal role in assessing risk. This approach has not been evaluated in children.Methods. We retrospectively evaluated 60 children ≤18 years old who underwent comprehensive electrophysiologic evaluation between 1979 and 1989 before undergoing operation for Wolff-Parkinson-White syndrome. Clinical and electrophysiologic data were analyzed after patients had been grouped by ther clinical presentation: high risk (cardiac arrest), intermediate risk (syncope or atrial fibrillation) or low risk (orthodromic reciprocating tachycardia alone).Results. Ten children had a clinical cardiac arrest (high risk); only one had a prior history of syncope or atrial fibrillation. Compared with the intermediate (n = 19) and low risk groups (n = 31), there were no differences in age ([mean ± SD] 14.8 ± 0.6 vs. 14.7 ± 0.6 vs. 14.5 ± 1.7 years), duration of symptoms (1.9 ± 0.5 vs. 4.1 ± 1.1 vs. 5.2 ± 0.8 years), incidence of congenital heart disease (30% vs. 26% vs. 32%), presence of multiple pathways (20% vs. 16% vs. 16%) or accessory pathway location. A shortest pre-excited RR interval <220 ms was found in 7 of 7 high risk patients (sensitivity 100%), 14 of 19 intermediate risk patients and 11 of 31 low risk patients (prevalence 35%).Conclusions. Cardiac arrest was the only distinguishing clinical feature between high and low risk groups and the first manifestation in 80% of the children of an accessory pathway that can precipitate a life-threatening arrhythmia. In this series, the largest reported to date of children with Wolff-Parkinson-White syndrome having a cardiac arrest, a shortest pre-excited RR interval <220 ms was more sensitive than clinical history for identifying those at risk for sudden death.</div></front></TEI><istex><corpusName>elsevier</corpusName><author><json:item><name>Burt I. Bromberg MD</name><affiliations><json:string>Department of Pediatrics, Cardiovascular Division of Internal Medicine and Division of Cardiovascular Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA</json:string></affiliations></json:item><json:item><name>Bruce D. Lindsay MD, FACC</name><affiliations><json:string>Department of Pediatrics, Cardiovascular Division of Internal Medicine and Division of Cardiovascular Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA</json:string></affiliations></json:item><json:item><name>Michael E. Cain MD, FACC</name><affiliations><json:string>Department of Pediatrics, Cardiovascular Division of Internal Medicine and Division of Cardiovascular Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA</json:string></affiliations></json:item><json:item><name>James L. Cox MD, FACC</name><affiliations><json:string>Department of Pediatrics, Cardiovascular Division of Internal Medicine and Division of Cardiovascular Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Electrophysiology</value></json:item></subject><articleId><json:string>95005196</json:string></articleId><language><json:string>eng</json:string></language><abstract>Objectives. This study sought to determine whether the clinical and electrophysiologic criteria developed in adults also identify children with Wolff-Parkinson-White syndrome at risk for sudden death.Background. In adults with Wolff-Parkinson-White syndrome, a shortest RR interval >220 ms during atrial fibrillation is a sensitive marker for sudden death. However, because reliance on the shortest RR interval has a low positive predictive value, the clinical history has assumed a pivotal role in assessing risk. This approach has not been evaluated in children.Methods. We retrospectively evaluated 60 children ≤18 years old who underwent comprehensive electrophysiologic evaluation between 1979 and 1989 before undergoing operation for Wolff-Parkinson-White syndrome. Clinical and electrophysiologic data were analyzed after patients had been grouped by ther clinical presentation: high risk (cardiac arrest), intermediate risk (syncope or atrial fibrillation) or low risk (orthodromic reciprocating tachycardia alone).Results. Ten children had a clinical cardiac arrest (high risk); only one had a prior history of syncope or atrial fibrillation. Compared with the intermediate (n = 19) and low risk groups (n = 31), there were no differences in age ([mean ± SD] 14.8 ± 0.6 vs. 14.7 ± 0.6 vs. 14.5 ± 1.7 years), duration of symptoms (1.9 ± 0.5 vs. 4.1 ± 1.1 vs. 5.2 ± 0.8 years), incidence of congenital heart disease (30% vs. 26% vs. 32%), presence of multiple pathways (20% vs. 16% vs. 16%) or accessory pathway location. A shortest pre-excited RR interval >220 ms was found in 7 of 7 high risk patients (sensitivity 100%), 14 of 19 intermediate risk patients and 11 of 31 low risk patients (prevalence 35%).Conclusions. Cardiac arrest was the only distinguishing clinical feature between high and low risk groups and the first manifestation in 80% of the children of an accessory pathway that can precipitate a life-threatening arrhythmia. In this series, the largest reported to date of children with Wolff-Parkinson-White syndrome having a cardiac arrest, a shortest pre-excited RR interval >220 ms was more sensitive than clinical history for identifying those at risk for sudden death.</abstract><qualityIndicators><score>5.97</score><pdfVersion>1.3</pdfVersion><pdfPageSize>576 x 756 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>1</keywordCount><abstractCharCount>2197</abstractCharCount><pdfWordCount>2970</pdfWordCount><pdfCharCount>20474</pdfCharCount><pdfPageCount>6</pdfPageCount><abstractWordCount>332</abstractWordCount></qualityIndicators><title>Impact of clinical history and electrophysiologic characterization of accessory pathways on management strategies to reduce sudden death among children with Wolff-Parkinson-White syndrome</title><pii><json:string>0735-1097(95)00519-6</json:string></pii><genre><json:string>research-article</json:string></genre><host><volume>27</volume><pii><json:string>S0735-1097(00)X0002-2</json:string></pii><pages><last>695</last><first>690</first></pages><issn><json:string>0735-1097</json:string></issn><issue>3</issue><genre><json:string>Journal</json:string></genre><language><json:string>unknown</json:string></language><title>Journal of the American College of Cardiology</title><publicationDate>1996</publicationDate></host><categories><wos><json:string>CARDIAC & CARDIOVASCULAR SYSTEMS</json:string></wos></categories><publicationDate>1995</publicationDate><copyrightDate>1996</copyrightDate><doi><json:string>10.1016/0735-1097(95)00519-6</json:string></doi><id>B98C2EA910E7B8D9F2D1BC59FE445006AF2B582E</id><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/B98C2EA910E7B8D9F2D1BC59FE445006AF2B582E/fulltext/pdf</uri></json:item><json:item><original>true</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/B98C2EA910E7B8D9F2D1BC59FE445006AF2B582E/fulltext/txt</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/B98C2EA910E7B8D9F2D1BC59FE445006AF2B582E/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/B98C2EA910E7B8D9F2D1BC59FE445006AF2B582E/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Impact of clinical history and electrophysiologic characterization of accessory pathways on management strategies to reduce sudden death among children with Wolff-Parkinson-White syndrome</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>ELSEVIER</p></availability><date>1996</date></publicationStmt><notesStmt><note type="content">Section title: Clinical study</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Impact of clinical history and electrophysiologic characterization of accessory pathways on management strategies to reduce sudden death among children with Wolff-Parkinson-White syndrome</title><author><persName><forename type="first">Burt I.</forename><surname>Bromberg</surname></persName><roleName type="degree">MD</roleName><affiliation>Address for correspondence: Dr. Bart I. Bromberg, Saint Louis Children's Hospital, One Children's Place, Saint Louis, Missouri 63110.</affiliation><affiliation>Department of Pediatrics, Cardiovascular Division of Internal Medicine and Division of Cardiovascular Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA</affiliation></author><author><persName><forename type="first">Bruce D.</forename><surname>Lindsay</surname></persName><roleName type="degree">MD, FACC</roleName><affiliation>Department of Pediatrics, Cardiovascular Division of Internal Medicine and Division of Cardiovascular Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA</affiliation></author><author><persName><forename type="first">Michael E.</forename><surname>Cain</surname></persName><roleName type="degree">MD, FACC</roleName><affiliation>Department of Pediatrics, Cardiovascular Division of Internal Medicine and Division of Cardiovascular Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA</affiliation></author><author><persName><forename type="first">James L.</forename><surname>Cox</surname></persName><roleName type="degree">MD, FACC</roleName><affiliation>Department of Pediatrics, Cardiovascular Division of Internal Medicine and Division of Cardiovascular Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA</affiliation></author></analytic><monogr><title level="j">Journal of the American College of Cardiology</title><title level="j" type="abbrev">JAC</title><idno type="pISSN">0735-1097</idno><idno type="PII">S0735-1097(00)X0002-2</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1995"></date><biblScope unit="volume">27</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="690">690</biblScope><biblScope unit="page" to="695">695</biblScope></imprint></monogr><idno type="istex">B98C2EA910E7B8D9F2D1BC59FE445006AF2B582E</idno><idno type="DOI">10.1016/0735-1097(95)00519-6</idno><idno type="PII">0735-1097(95)00519-6</idno><idno type="ArticleID">95005196</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1996</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Objectives. This study sought to determine whether the clinical and electrophysiologic criteria developed in adults also identify children with Wolff-Parkinson-White syndrome at risk for sudden death.Background. In adults with Wolff-Parkinson-White syndrome, a shortest RR interval <220 ms during atrial fibrillation is a sensitive marker for sudden death. However, because reliance on the shortest RR interval has a low positive predictive value, the clinical history has assumed a pivotal role in assessing risk. This approach has not been evaluated in children.Methods. We retrospectively evaluated 60 children ≤18 years old who underwent comprehensive electrophysiologic evaluation between 1979 and 1989 before undergoing operation for Wolff-Parkinson-White syndrome. Clinical and electrophysiologic data were analyzed after patients had been grouped by ther clinical presentation: high risk (cardiac arrest), intermediate risk (syncope or atrial fibrillation) or low risk (orthodromic reciprocating tachycardia alone).Results. Ten children had a clinical cardiac arrest (high risk); only one had a prior history of syncope or atrial fibrillation. Compared with the intermediate (n = 19) and low risk groups (n = 31), there were no differences in age ([mean ± SD] 14.8 ± 0.6 vs. 14.7 ± 0.6 vs. 14.5 ± 1.7 years), duration of symptoms (1.9 ± 0.5 vs. 4.1 ± 1.1 vs. 5.2 ± 0.8 years), incidence of congenital heart disease (30% vs. 26% vs. 32%), presence of multiple pathways (20% vs. 16% vs. 16%) or accessory pathway location. A shortest pre-excited RR interval <220 ms was found in 7 of 7 high risk patients (sensitivity 100%), 14 of 19 intermediate risk patients and 11 of 31 low risk patients (prevalence 35%).Conclusions. Cardiac arrest was the only distinguishing clinical feature between high and low risk groups and the first manifestation in 80% of the children of an accessory pathway that can precipitate a life-threatening arrhythmia. In this series, the largest reported to date of children with Wolff-Parkinson-White syndrome having a cardiac arrest, a shortest pre-excited RR interval <220 ms was more sensitive than clinical history for identifying those at risk for sudden death.</p></abstract><textClass><keywords scheme="keyword"><list><head>Article category</head><item><term>Electrophysiology</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="1995-10-17">Registration</change><change when="1995-10-02">Modified</change><change when="1995">Published</change></revisionDesc></teiHeader></istex:fulltextTEI></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier doc found" wicri:toSee="Elsevier, no converted or simple article"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" </istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 5.1.0//EN//XML" URI="art510.dtd" name="istex:docType"></istex:docType><istex:document><article version="5.1" xml:lang="en" docsubtype="fla"><item-info><jid>JAC</jid><aid>95005196</aid><ce:pii>0735-1097(95)00519-6</ce:pii><ce:doi>10.1016/0735-1097(95)00519-6</ce:doi><ce:copyright type="unknown" year="1996"></ce:copyright><ce:doctopics><ce:doctopic><ce:text>Electrophysiology</ce:text></ce:doctopic></ce:doctopics></item-info><head><ce:dochead><ce:textfn>Clinical study</ce:textfn></ce:dochead><ce:title>Impact of clinical history and electrophysiologic characterization of accessory pathways on management strategies to reduce sudden death among children with Wolff-Parkinson-White syndrome</ce:title><ce:author-group><ce:author><ce:given-name>Burt I.</ce:given-name><ce:surname>Bromberg</ce:surname><ce:degrees>MD</ce:degrees><ce:cross-ref refid="COR1"><ce:sup>∗</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Bruce D.</ce:given-name><ce:surname>Lindsay</ce:surname><ce:degrees>MD, FACC</ce:degrees></ce:author><ce:author><ce:given-name>Michael E.</ce:given-name><ce:surname>Cain</ce:surname><ce:degrees>MD, FACC</ce:degrees></ce:author><ce:author><ce:given-name>James L.</ce:given-name><ce:surname>Cox</ce:surname><ce:degrees>MD, FACC</ce:degrees></ce:author><ce:affiliation><ce:textfn>Department of Pediatrics, Cardiovascular Division of Internal Medicine and Division of Cardiovascular Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA</ce:textfn></ce:affiliation><ce:correspondence id="COR1"><ce:label>∗</ce:label><ce:text><ce:underline>Address for correspondence</ce:underline>: Dr. Bart I. Bromberg, Saint Louis Children's Hospital, One Children's Place, Saint Louis, Missouri 63110.</ce:text></ce:correspondence></ce:author-group><ce:date-received day="7" month="4" year="1995"></ce:date-received><ce:date-revised day="2" month="10" year="1995"></ce:date-revised><ce:date-accepted day="17" month="10" year="1995"></ce:date-accepted><ce:abstract><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para id="SP0005"><ce:italic>Objectives</ce:italic>. This study sought to determine whether the clinical and electrophysiologic criteria developed in adults also identify children with Wolff-Parkinson-White syndrome at risk for sudden death.</ce:simple-para><ce:simple-para id="SP0010"><ce:italic>Background</ce:italic>. In adults with Wolff-Parkinson-White syndrome, a shortest RR interval <220 ms during atrial fibrillation is a sensitive marker for sudden death. However, because reliance on the shortest RR interval has a low positive predictive value, the clinical history has assumed a pivotal role in assessing risk. This approach has not been evaluated in children.</ce:simple-para><ce:simple-para id="SP0015"><ce:italic>Methods</ce:italic>. We retrospectively evaluated 60 children ≤18 years old who underwent comprehensive electrophysiologic evaluation between 1979 and 1989 before undergoing operation for Wolff-Parkinson-White syndrome. Clinical and electrophysiologic data were analyzed after patients had been grouped by ther clinical presentation: high risk (cardiac arrest), intermediate risk (syncope or atrial fibrillation) or low risk (orthodromic reciprocating tachycardia alone).</ce:simple-para><ce:simple-para id="SP0020"><ce:italic>Results</ce:italic>. Ten children had a clinical cardiac arrest (high risk); only one had a prior history of syncope or atrial fibrillation. Compared with the intermediate (n = 19) and low risk groups (n = 31), there were no differences in age ([mean ± SD] 14.8 ± 0.6 vs. 14.7 ± 0.6 vs. 14.5 ± 1.7 years), duration of symptoms (1.9 ± 0.5 vs. 4.1 ± 1.1 vs. 5.2 ± 0.8 years), incidence of congenital heart disease (30% vs. 26% vs. 32%), presence of multiple pathways (20% vs. 16% vs. 16%) or accessory pathway location. A shortest pre-excited RR interval <220 ms was found in 7 of 7 high risk patients (sensitivity 100%), 14 of 19 intermediate risk patients and 11 of 31 low risk patients (prevalence 35%).</ce:simple-para><ce:simple-para id="SP0025"><ce:italic>Conclusions</ce:italic>. Cardiac arrest was the only distinguishing clinical feature between high and low risk groups and the first manifestation in 80% of the children of an accessory pathway that can precipitate a life-threatening arrhythmia. In this series, the largest reported to date of children with Wolff-Parkinson-White syndrome having a cardiac arrest, a shortest pre-excited RR interval <220 ms was more sensitive than clinical history for identifying those at risk for sudden death.</ce:simple-para></ce:abstract-sec></ce:abstract></head><tail><ce:bibliography id="R0005"><ce:section-title>References</ce:section-title><ce:bibliography-sec id="RS0005"><ce:bib-reference id="BIB1"><ce:label>1.</ce:label><sb:reference><sb:contribution><sb:authors><sb:author><ce:given-name>A.</ce:given-name><ce:surname>Ludomirsky</ce:surname></sb:author><sb:author><ce:given-name>A.</ce:given-name><ce:surname>Garson</ce:surname><ce:suffix>Jr.</ce:suffix></sb:author></sb:authors><sb:title><sb:maintitle>The Science and Practice of Pediatric Cardiology</sb:maintitle></sb:title></sb:contribution><sb:host><sb:edited-book><sb:date>1990</sb:date><sb:publisher><sb:name>Lea & 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Implications for ablation procedures in small children</sb:maintitle></sb:title></sb:contribution><sb:host><sb:issue><sb:series><sb:title><sb:maintitle>Circulation</sb:maintitle></sb:title><sb:volume-nr>90</sb:volume-nr></sb:series><sb:date>1994</sb:date></sb:issue><sb:pages><sb:first-page>492</sb:first-page><sb:last-page>499</sb:last-page></sb:pages></sb:host></sb:reference></ce:bib-reference></ce:bibliography-sec></ce:bibliography></tail></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Impact of clinical history and electrophysiologic characterization of accessory pathways on management strategies to reduce sudden death among children with Wolff-Parkinson-White syndrome</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Impact of clinical history and electrophysiologic characterization of accessory pathways on management strategies to reduce sudden death among children with Wolff-Parkinson-White syndrome</title></titleInfo><name type="personal"><namePart type="given">Burt I.</namePart><namePart type="family">Bromberg</namePart><namePart type="termsOfAddress">MD</namePart><affiliation>Department of Pediatrics, Cardiovascular Division of Internal Medicine and Division of Cardiovascular Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA</affiliation><description>Address for correspondence: Dr. Bart I. Bromberg, Saint Louis Children's Hospital, One Children's Place, Saint Louis, Missouri 63110.</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Bruce D.</namePart><namePart type="family">Lindsay</namePart><namePart type="termsOfAddress">MD, FACC</namePart><affiliation>Department of Pediatrics, Cardiovascular Division of Internal Medicine and Division of Cardiovascular Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Michael E.</namePart><namePart type="family">Cain</namePart><namePart type="termsOfAddress">MD, FACC</namePart><affiliation>Department of Pediatrics, Cardiovascular Division of Internal Medicine and Division of Cardiovascular Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">James L.</namePart><namePart type="family">Cox</namePart><namePart type="termsOfAddress">MD, FACC</namePart><affiliation>Department of Pediatrics, Cardiovascular Division of Internal Medicine and Division of Cardiovascular Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">1995</dateIssued><dateValid encoding="w3cdtf">1995-10-17</dateValid><dateModified encoding="w3cdtf">1995-10-02</dateModified><copyrightDate encoding="w3cdtf">1996</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">Objectives. This study sought to determine whether the clinical and electrophysiologic criteria developed in adults also identify children with Wolff-Parkinson-White syndrome at risk for sudden death.Background. In adults with Wolff-Parkinson-White syndrome, a shortest RR interval <220 ms during atrial fibrillation is a sensitive marker for sudden death. However, because reliance on the shortest RR interval has a low positive predictive value, the clinical history has assumed a pivotal role in assessing risk. This approach has not been evaluated in children.Methods. We retrospectively evaluated 60 children ≤18 years old who underwent comprehensive electrophysiologic evaluation between 1979 and 1989 before undergoing operation for Wolff-Parkinson-White syndrome. Clinical and electrophysiologic data were analyzed after patients had been grouped by ther clinical presentation: high risk (cardiac arrest), intermediate risk (syncope or atrial fibrillation) or low risk (orthodromic reciprocating tachycardia alone).Results. Ten children had a clinical cardiac arrest (high risk); only one had a prior history of syncope or atrial fibrillation. Compared with the intermediate (n = 19) and low risk groups (n = 31), there were no differences in age ([mean ± SD] 14.8 ± 0.6 vs. 14.7 ± 0.6 vs. 14.5 ± 1.7 years), duration of symptoms (1.9 ± 0.5 vs. 4.1 ± 1.1 vs. 5.2 ± 0.8 years), incidence of congenital heart disease (30% vs. 26% vs. 32%), presence of multiple pathways (20% vs. 16% vs. 16%) or accessory pathway location. A shortest pre-excited RR interval <220 ms was found in 7 of 7 high risk patients (sensitivity 100%), 14 of 19 intermediate risk patients and 11 of 31 low risk patients (prevalence 35%).Conclusions. Cardiac arrest was the only distinguishing clinical feature between high and low risk groups and the first manifestation in 80% of the children of an accessory pathway that can precipitate a life-threatening arrhythmia. In this series, the largest reported to date of children with Wolff-Parkinson-White syndrome having a cardiac arrest, a shortest pre-excited RR interval <220 ms was more sensitive than clinical history for identifying those at risk for sudden death.</abstract><note type="content">Section title: Clinical study</note><subject><genre>Article category</genre><topic>Electrophysiology</topic></subject><relatedItem type="host"><titleInfo><title>Journal of the American College of Cardiology</title></titleInfo><titleInfo type="abbreviated"><title>JAC</title></titleInfo><genre type="Journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">19960301</dateIssued></originInfo><identifier type="ISSN">0735-1097</identifier><identifier type="PII">S0735-1097(00)X0002-2</identifier><part><detail type="volume"><number>27</number><caption>vol.</caption></detail><detail type="issue"><number>3</number><caption>no.</caption></detail><extent unit="issue pages"><start>A21</start><end>A48</end></extent><extent unit="issue pages"><start>517</start><end>756</end></extent><extent unit="pages"><start>690</start><end>695</end></extent></part></relatedItem><identifier type="istex">B98C2EA910E7B8D9F2D1BC59FE445006AF2B582E</identifier><identifier type="DOI">10.1016/0735-1097(95)00519-6</identifier><identifier type="PII">0735-1097(95)00519-6</identifier><identifier type="ArticleID">95005196</identifier><recordInfo><recordContentSource>ELSEVIER</recordContentSource></recordInfo></mods></metadata><enrichments><istex:catWosTEI uri="https://api.istex.fr/document/B98C2EA910E7B8D9F2D1BC59FE445006AF2B582E/enrichments/catWos"><teiHeader><profileDesc><textClass><classCode scheme="WOS">CARDIAC & CARDIOVASCULAR SYSTEMS</classCode></textClass></profileDesc></teiHeader></istex:catWosTEI></enrichments><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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