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Loss of Ventricular Pre-excitation During Non-invasive Testing Does Not Exclude High-Risk Accessory Pathways: A Multicenter Study of WPW in Children. Heart rhythm Escudero, C. A., Ceresnak, S. R., Collins, K. K., Pass, R. H., Aziz, P. F., Blaufox, A. D., Ortega, M. C., Cannon, B. C., Cohen, M. n., Dechert, B. E., Dubin, A. M., Motonaga, K. S., Epstein, M. R., Erickson, C. C., Fishberger, S. B., Gates, G. J., Capone, C. A., Nappo, L. n., Kertesz, N. J., Kim, J. J., Valdes, S. O., Kubuš, P. n., Law, I. H., Maldonado, J. n., Moore, J. P., Perry, J. C., Sanatani, S. n., Seslar, S. P., Shetty, I. n., Zimmerman, F. J., Skinner, J. R., Marcondes, L. n., Stephenson, E. A., Asakai, H. n., Tanel, R. E., Uzun, O. n., Etheridge, S. P., Janson, C. n. 2020

Abstract

Abrupt loss of ventricular pre-excitation on non-invasive evaluation, or non-persistent pre-excitation, in Wolff-Parkinson-White syndrome (WPW) is thought to indicate a low risk of life-threatening events.To compare accessory pathway (AP) characteristics and occurrences of sudden cardiac arrest (SCA) and rapidly conducted pre-excited atrial fibrillation (RC-AF) in patients with non-persistent and persistent pre-excitation.Patients =21 years with WPW and invasive electrophysiology study (EPS) data, SCA, or RC-AF were identified from multicenter databases. Non-persistent pre-excitation was defined as absence/sudden loss of pre-excitation on ECG, Holter, or exercise test. RC-AF was defined as clinical pre-excited atrial fibrillation with shortest pre-excited R-R interval (SPERRI) =250ms. AP effective refractory period (APERP), SPERRI at EPS (EPS-SPERRI), and shortest pre-excited paced cycle length (SPPCL) were collected. High-risk APs were defined as APERP, SPERRI, or SPPCL =250ms.Of 1589 patients, 244 (15%) had non-persistent pre-excitation and 1345 (85%) had persistent pre-excitation. There were no differences in sex (58 vs 60% male, p=0.49) or age (13.3±3.6 vs 13.1±3.9 years, p=0.43) between groups. Though APERP (344±76 vs 312±61ms, p<0.001), and SPPCL (394±123 vs 317±82ms, p<0.001) were longer in non-persistent versus persistent pre-excitation, there was no difference in EPS-SPERRI (331±71 vs 316±73ms, p=0.15). Non-persistent pre-excitation was associated with fewer high-risk APs (13 vs 23%, p<0.001) than persistent pre-excitation. Of 61 patients with SCA or RC-AF, 6 (10%) had non-persistent pre-excitation (3 SCA, 3 RC-AF).Non-persistent pre-excitation was associated with fewer high-risk APs, though it did not exclude risk of SCA or RC-AF in children with WPW.

View details for DOI 10.1016/j.hrthm.2020.05.035

View details for PubMedID 32497761