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Loss of ventricular preexcitation during noninvasive testing does not exclude high-risk accessory pathways: A multicenter study of WPW in children
CA. Escudero, SR. Ceresnak, KK. Collins, RH. Pass, PF. Aziz, AD. Blaufox, MC. Ortega, BC. Cannon, MI. Cohen, BE. Dechert, AM. Dubin, KS. Motonaga, MR. Epstein, CC. Erickson, SB. Fishberger, GJ. Gates, CA. Capone, L. Nappo, NJ. Kertesz, JJ. Kim,...
Language English Country United States
Document type Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't
- MeSH
- Global Health MeSH
- Electrocardiography, Ambulatory methods MeSH
- Risk Assessment methods MeSH
- Incidence MeSH
- Humans MeSH
- Survival Rate trends MeSH
- Adolescent MeSH
- Death, Sudden, Cardiac epidemiology etiology MeSH
- Follow-Up Studies MeSH
- Heart Conduction System physiopathology MeSH
- Retrospective Studies MeSH
- Wolff-Parkinson-White Syndrome complications physiopathology MeSH
- Exercise Test MeSH
- Check Tag
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
BACKGROUND: Abrupt loss of ventricular preexcitation on noninvasive evaluation, or nonpersistent preexcitation, in Wolff-Parkinson-White syndrome (WPW) is thought to indicate a low risk of life-threatening events. OBJECTIVE: The purpose of this study was to compare accessory pathway (AP) characteristics and occurrences of sudden cardiac arrest (SCA) and rapidly conducted preexcited atrial fibrillation (RC-AF) in patients with nonpersistent and persistent preexcitation. METHODS: Patients 21 years or younger with WPW and invasive electrophysiology study (EPS) data, SCA, or RC-AF were identified from multicenter databases. Nonpersistent preexcitation was defined as absence/sudden loss of preexcitation on electrocardiogram, Holter monitoring, or exercise stress test. RC-AF was defined as clinical preexcited atrial fibrillation with shortest preexcited R-R interval (SPERRI) ≤ 250 ms. AP effective refractory period (APERP), SPERRI at EPS , and shortest preexcited paced cycle length (SPPCL) were collected. High-risk APs were defined as APERP, SPERRI, or SPPCL ≤ 250 ms. RESULTS: Of 1589 patients, 244 (15%) had nonpersistent preexcitation and 1345 (85%) had persistent preexcitation. There were no differences in sex (58% vs 60% male; P=.49) or age (13.3±3.6 years vs 13.1±3.9 years; P=.43) between groups. Although APERP (344±76 ms vs 312±61 ms; P<.001) and SPPCL (394±123 ms vs 317±82 ms; P<.001) were longer in nonpersistent vs persistent preexcitation, there was no difference in SPERRI at EPS (331±71 ms vs 316±73 ms; P=.15). Nonpersistent preexcitation was associated with fewer high-risk APs (13% vs 23%; P<.001) than persistent preexcitation. Of 61 patients with SCA or RC-AF, 6 (10%) had nonpersistent preexcitation (3 SCA, 3 RC-AF). CONCLUSION: Nonpersistent preexcitation was associated with fewer high-risk APs, though it did not exclude the risk of SCA or RC-AF in children with WPW.
Department of Arrhythmia and Cardiac Pacing Cardiocentro Pediatrico William Soler Havana Cuba
Department of Paediatric Cardiology University Hospital of Wales Cardiff Wales United Kingdom
Department of Pediatrics Division of Cardiology Seattle Children's Hospital Seattle Washington
Department of Pediatrics Division of Cardiology Texas Children's Hospital Houston Texas
Department of Pediatrics Division of Cardiology University of Colorado Aurora Colorado
Department of Pediatrics Division of Pediatric Cardiology UCLA Medical Center Los Angeles California
Department of Pediatrics University of Michigan Ann Arbor Michigan
Department of Pediatrics University of Tokyo Hospital Tokyo Japan
Division of Cardiology Miami Children's Hospital Miami Florida
Division of Cardiology Nationwide Children's Columbus Ohio
Division of Pediatric Cardiology Inova Children's Hospital Fairfax Virginia
Division of Pediatric Cardiology Maine Medical Center Portland Maine
Division of Pediatric Cardiology Mayo Clinic Rochester Minnesota
Division of Pediatric Cardiology The Children's Hospital at Montefiore Medical Center Bronx New York
Division of Pediatric Cardiology UNMC CUMC Children's Hospital and Medical Center Omaha Nebraska
References provided by Crossref.org
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- $a Escudero, Carolina A $u Department of Pediatrics, Division of Pediatric Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada. Electronic address: escudero@ualberta.ca
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- $a Loss of ventricular preexcitation during noninvasive testing does not exclude high-risk accessory pathways: A multicenter study of WPW in children / $c CA. Escudero, SR. Ceresnak, KK. Collins, RH. Pass, PF. Aziz, AD. Blaufox, MC. Ortega, BC. Cannon, MI. Cohen, BE. Dechert, AM. Dubin, KS. Motonaga, MR. Epstein, CC. Erickson, SB. Fishberger, GJ. Gates, CA. Capone, L. Nappo, NJ. Kertesz, JJ. Kim, SO. Valdes, P. Kubuš, IH. Law, J. Maldonado, JP. Moore, JC. Perry, S. Sanatani, SP. Seslar, I. Shetty, FJ. Zimmerman, JR. Skinner, L. Marcondes, EA. Stephenson, H. Asakai, RE. Tanel, O. Uzun, SP. Etheridge, CM. Janson
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- $a BACKGROUND: Abrupt loss of ventricular preexcitation on noninvasive evaluation, or nonpersistent preexcitation, in Wolff-Parkinson-White syndrome (WPW) is thought to indicate a low risk of life-threatening events. OBJECTIVE: The purpose of this study was to compare accessory pathway (AP) characteristics and occurrences of sudden cardiac arrest (SCA) and rapidly conducted preexcited atrial fibrillation (RC-AF) in patients with nonpersistent and persistent preexcitation. METHODS: Patients 21 years or younger with WPW and invasive electrophysiology study (EPS) data, SCA, or RC-AF were identified from multicenter databases. Nonpersistent preexcitation was defined as absence/sudden loss of preexcitation on electrocardiogram, Holter monitoring, or exercise stress test. RC-AF was defined as clinical preexcited atrial fibrillation with shortest preexcited R-R interval (SPERRI) ≤ 250 ms. AP effective refractory period (APERP), SPERRI at EPS , and shortest preexcited paced cycle length (SPPCL) were collected. High-risk APs were defined as APERP, SPERRI, or SPPCL ≤ 250 ms. RESULTS: Of 1589 patients, 244 (15%) had nonpersistent preexcitation and 1345 (85%) had persistent preexcitation. There were no differences in sex (58% vs 60% male; P=.49) or age (13.3±3.6 years vs 13.1±3.9 years; P=.43) between groups. Although APERP (344±76 ms vs 312±61 ms; P<.001) and SPPCL (394±123 ms vs 317±82 ms; P<.001) were longer in nonpersistent vs persistent preexcitation, there was no difference in SPERRI at EPS (331±71 ms vs 316±73 ms; P=.15). Nonpersistent preexcitation was associated with fewer high-risk APs (13% vs 23%; P<.001) than persistent preexcitation. Of 61 patients with SCA or RC-AF, 6 (10%) had nonpersistent preexcitation (3 SCA, 3 RC-AF). CONCLUSION: Nonpersistent preexcitation was associated with fewer high-risk APs, though it did not exclude the risk of SCA or RC-AF in children with WPW.
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- $a Ceresnak, Scott R $u Division of Pediatric Cardiology, Department of Cardiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
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