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Assessing the utility of atrial fibrillation induction to risk stratify children with Wolff–Parkinson–White syndrome

Published online by Cambridge University Press:  13 June 2023

Gabriel Apfel Open the ORCID record for Gabriel Apfel [Opens in a new window] ,
Nak Hyun Choi ,
Eric S. Silver  and
Leonardo Liberman
Gabriel Apfel
Affiliation:
New York-Presbyterian, Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, New York, NY, USA
Nak Hyun Choi
Affiliation:
New York-Presbyterian, Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, New York, NY, USA
Eric S. Silver
Affiliation:
New York-Presbyterian, Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, New York, NY, USA
Leonardo Liberman*
Affiliation:
New York-Presbyterian, Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, New York, NY, USA
*
Corresponding author: Leonardo Liberman; Email: ll202@cumc.columbia.edu
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Abstract

Background:

Wolff–Parkinson–White syndrome is associated with sudden cardiac death from rapid conduction through the accessory pathway in atrial fibrillation. Adult patients are at higher risk for sudden cardiac death if the shortest-pre-excited-RR-interval in atrial fibrillation (SPERRI) is ≤250 milliseconds (msec) during electrophysiologic study. Exclusive conduction through the atrioventricular node in atrial fibrillation is presumed to convey lower risk. The shortest-pre-excited-paced-cycle-length with atrial pacing has also served as a marker for risk stratification.

Objective:

To determine accessory pathway characteristic of patients undergoing induction of atrial fibrillation during electrophysiologic study.

Methods:

We reviewed 321 pediatric patients that underwent electrophysiologic study between 2010 and 2019. Induction of atrial fibrillation was attempted on patients while on isoproterenol and SPERRI was measured if atrial fibrillation was induced. Shortest-pre-excited-paced-cycle-length (SPPCL) was determined while on isoproterenol.

Results:

Atrial fibrillation was induced in 233 (73%) patients. Of those, 104 (45%) patients conducted exclusively through the atrioventricular node during atrial fibrillation (Group A). The remaining 129 (55%) patients had some conduction through the accessory pathway (Group B). In Group A, SPPCL was 260 msec with 48 (46%) conducting through the accessory pathway at ≤250 msec. In Group B, SPPCL was 240 msec with 92 patients (71%) conducting at ≤250 msec (p < 0.05). In Group B, SPERRI was 250 msec and had a positive correlation with SPPCL (p < 0.001, R2 = 0.28). Almost half (46%) of those with exclusive conduction through the atrioventricular node in atrial fibrillation had rapid accessory pathway conduction with atrial pacing.

Conclusion:

Conduction in atrial fibrillation during electrophysiologic study on isoproterenol via the atrioventricular node may not exclude high-risk accessory pathways in pediatric patients.

Keywords

WPW – Wolff-Parkinson-WhiteSCD – sudden cardiac deathAP – accessory pathwaySPERRI – shortest-pre-excited-RR-intervalSPPCL – shortest-pre-excited-paced-cycle-length
Type
Original Article
Information
Cardiology in the Young , First View , pp. 1 - 5
Copyright
© The Author(s), 2023. Published by Cambridge University Press

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