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 : 002170 ( Main/Exploration ); précédent : 002169; suivant : 002171Impact 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 [États-Unis] ; Bruce D. Lindsay [États-Unis] ; Michael E. Cain [États-Unis] ; James L. Cox [États-Unis]Source :
- 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.
Url:
DOI: 10.1016/0735-1097(95)00519-6
Affiliations:
- États-Unis
- Missouri (État)
- Saint-Louis (Missouri)
- École de médecine (Université Washington de Saint-Louis)
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<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>
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