Risk-Stratification Strategy for Sudden Cardiac Death in the Very Young Children with Asymptomatic Ventricular Preexcitation

Author(s): Moises Rodriguez-Gonzalez*, Ana Castellano-Martinez, Alvaro A. Perez-Reviriego

Journal Name: Current Cardiology Reviews

Volume 16 , Issue 2 , 2020

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Graphical Abstract:


Abstract:

Asymptomatic VPE refers to the presence of this abnormal ECG pattern in the absence of any symptoms. The natural history in these patients is usually benign, and most children (60%) with VPE are usually asymptomatic. However, Sudden Cardiac Death (SCD) has been reported to be the initial symptom in many patients too. The increased risk of SCD is thought to be due to the rapid conduction of atrial arrhythmias to the ventricle, via the AP, which degenerates into Ventricular Fibrillation (VF). The best method to identify high-risk patients with asymptomatic VPE for SCD is the characterization of the electrophysiological properties of the AP through an Electrophysiological Study (EPS). Also, catheter ablation of the AP with radiofrequency as definitive treatment to avoid SCD can be performed by the same procedure with high rates of success. However, the uncertainty over the absolute risk of SCD, the poor positive predictive value of an invasive EPS, and complications associated with catheter ablation have made the management of asymptomatic VPE challenging, even more in those children younger than 8-year-old, where there are no clear recommendations. This review provides an overview of the different methods to make the risk stratification for SCD in asymptomatic children with, as well as our viewpoint on the adequate approach to those young children not included in current guidelines.

Keywords: Wolff-parkinson-white syndrome, sudden cardiac death, ventricular preexcitation, infant, atrioventricular accessory pathways, ventricular fibrillation.

[1]
Triedman JK. Management of asymptomatic Wolff-Parkinson-White syndrome. Heart 2009; 95(19): 1628-34.
[http://dx.doi.org/10.1136/hrt.2008.151175] [PMID: 19752209]
[2]
Klein GJ, Gula LJ, Krahn AD, Skanes AC, Yee R. WPW pattern in the asymptomatic individual: has anything changed? Circ Arrhythm Electrophysiol 2009; 2(2): 97-9.
[http://dx.doi.org/10.1161/CIRCEP.109.859827] [PMID: 19808451]
[3]
Munger TM, Packer DL, Hammill SC, et al. A population study of the natural history of Wolff-Parkinson-White syndrome in Olmsted County, Minnesota, 1953-1989. Circulation 1993; 87(3): 866-73.
[http://dx.doi.org/10.1161/01.CIR.87.3.866] [PMID: 8443907]
[4]
Corrado D, Pelliccia A, Bjornstad HH, et al. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden cardiac death: Proposal for a common European protocol. Consensus statement of the Study Group of Sport Cardiology of the working group of Cardiac Rehabilitation and Exercise Physiology and the working group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J 2005; 26: 516-24.
[http://dx.doi.org/10.1093/eurheartj/ehi108] [PMID: 15689345]
[5]
Santinelli V, Radinovic A, Manguso F, et al. The natural history of asymptomatic ventricular pre-excitation a long-term prospective follow-up study of 184 asymptomatic children. J Am Coll Cardiol 2009; 53(3): 275-80.
[http://dx.doi.org/10.1016/j.jacc.2008.09.037] [PMID: 19147045]
[6]
Cain N, Irving C, Webber S, Beerman L, Arora G. Natural history of Wolff-Parkinson-White syndrome diagnosed in childhood. Am J Cardiol 2013; 112(7): 961-5.
[http://dx.doi.org/10.1016/j.amjcard.2013.05.035] [PMID: 23827401]
[7]
Hoeffler CD, Krenek ME, Brand MC. Wolff–parkinson–white syndrome in a term infant presenting with cardiopulmonary arrest. Adv Neonatal Care 2016; 16(1): 44-51.
[http://dx.doi.org/10.1097/ANC.0000000000000246] [PMID: 26742096]
[8]
Kruser TJ, Frank JL, Maginot KR. Recurrent syncope secondary to asystole in an infant with Wolff-Parkinson-White syndrome. Clin Pediatr (Phila) 2008; 47(7): 701-4.
[http://dx.doi.org/10.1177/0009922808316994] [PMID: 18698098]
[9]
Timmermans C, Smeets JL, Rodriguez LM, Vrouchos G, van den Dool A, Wellens HJ. Aborted sudden death in the Wolff-Parkinson-White syndrome. Am J Cardiol 1995; 76(7): 492-4.
[http://dx.doi.org/10.1016/S0002-9149(99)80136-2] [PMID: 7653450]
[10]
Dreifus LS, Haiat R, Watanabe Y, Arriaga J, Reitman N. Ventricular fibrillation. A possible mechanism of sudden death in patients and Wolff-Parkinson-White syndrome. Circulation 1971; 43(4): 520-7.
[http://dx.doi.org/10.1161/01.CIR.43.4.520] [PMID: 5573385]
[11]
Obeyesekere MN, Leong-Sit P, Massel D, et al. Risk of arrhythmia and sudden death in patients with asymptomatic preexcitation: A meta-analysis. Circulation 2012; 125(19): 2308-15.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.111.055350] [PMID: 22532593]
[12]
Dubin AM, Collins KK, Chiesa N, Hanisch D, Van Hare GF. Use of electrophysiologic testing to assess risk in children with Wolff-Parkinson-White syndrome. Cardiol Young 2002; 12(3): 248-52.
[http://dx.doi.org/10.1017/S1047951102000549] [PMID: 12365171]
[13]
Pappone C, Santinelli V, Rosanio S, et al. Usefulness of invasive electrophysiologic testing to stratify the risk of arrhythmic events in asymptomatic patients with Wolff-Parkinson-White pattern: results from a large prospective long-term follow-up study. J Am Coll Cardiol 2003; 41(2): 239-44.
[http://dx.doi.org/10.1016/S0735-1097(02)02706-7] [PMID: 12535816]
[14]
Pappone C, Manguso F, Santinelli R, et al. Radiofrequency ablation in children with asymptomatic Wolff-Parkinson-White syndrome. N Engl J Med 2004; 351(12): 1197-205.
[http://dx.doi.org/10.1056/NEJMoa040625] [PMID: 15371577]
[15]
Sarubbi B, D’Alto M, Vergara P, et al. Electrophysiological evaluation of asymptomatic ventricular pre-excitation in children and adolescents. Int J Cardiol 2005; 98(2): 207-14.
[http://dx.doi.org/10.1016/j.ijcard.2003.10.017] [PMID: 15686769]
[16]
Cohen MI, Triedman JK, Cannon BC, et al. PACES/HRS expert consensus statement on the management of the asymptomatic young patient with a Wolf-Parkinson-White electrocardiographic pattern. Heart Rhythm 2012; 9(6): 1006-24.
[http://dx.doi.org/10.1016/j.hrthm.2012.03.050] [PMID: 22579340]
[17]
Scheinman M, Calkins H, Gillette P, et al. NASPE policy statement on catheter ablation: personnel, policy, procedures, and therapeutic recommendations. Pacing Clin Electrophysiol 2003; 26(3): 789-99.
[http://dx.doi.org/10.1046/j.1460-9592.2003.00139.x] [PMID: 12698688]
[18]
Pietersen AH, Andersen ED, Sandoe E. Atrial fibrillation in the Wolff-Parkinson-White syndrome. Am J Cardiol 1992. 38A-43A:70.
[http://dx.doi.org/10.1016/0002-9149(92)91076-G]
[19]
Della Bella P, Brugada P, Talajic M, et al. Atrial fibrillation in patients with an accessory pathway: importance of the conduction properties of the accessory pathway. J Am Coll Cardiol 1991; 17(6): 1352-6.
[http://dx.doi.org/10.1016/S0735-1097(10)80146-9] [PMID: 2016453]
[20]
Medeiros A, Iturralde P, Guevara M, et al. Sudden death in intermittent WPW. Arch Cardiol Mex 2001; 71(1): 59-65.
[PMID: 11565363]
[21]
Kiger ME, McCanta AC, Tong S, Schaffer M, Runciman M, Collins KK. Intermittent vs. persistent Wolff-Parkinson-White syndro syndrome in children: Electrophysiologic properties and clinical outcomes. Pacing Clin Electrophysiol 2016; 39(1): 14-20.
[http://dx.doi.org/10.1111/pace.12732] [PMID: 26256551]
[22]
Gaita F, Giustetto C, Riccardi R, et al. Stress and pharmacologic tests as methods to identify patients with WPW syndrome at risk of sudden death. J Am Coll Cardiol 1987; 10: 373-81.
[23]
Brembilla-Perrot B, Chometon F, Groben L, et al. Interest of non-invasive and semi-invasive testings in asymptomatic children with pre-excitation syndrome. Europace 2007; 9(9): 837-43.
[http://dx.doi.org/10.1093/europace/eum153] [PMID: 17670785]
[24]
Campbell RM, Strieper MJ, Frias PA, Collins KK, Van Hare GF, Dubin AM. Survey of current practice of pediatric electrophysiologists for asymptomatic Wolff-Parkinson-White syndrome. Pediatrics 2003; 111(3): e245-7.
[http://dx.doi.org/10.1542/peds.111.3.e245] [PMID: 12612279]
[25]
Pappone C, Santinelli V, Manguso F, et al. A randomized study of prophylactic catheter ablation in asymptomatic patients with the Wolff-Parkinson-White syndrome. N Engl J Med 2003; 349(19): 1803-11.
[http://dx.doi.org/10.1056/NEJMoa035345] [PMID: 14602878]
[26]
Toni L, Blaufox AD. Transesophageal evaluation of asymptomatic Wolff-Parkinson-White syndrome. Pacing Clin Electrophysiol 2012; 35(5): 519-23.
[http://dx.doi.org/10.1111/j.1540-8159.2012.03339.x] [PMID: 22360708]
[27]
Kubuš P, Vít P, Gebauer RA, Materna O, Janoušek J. Electrophysiologic profile and results of invasive risk stratification in asymptomatic children and adolescents with the Wolff-Parkinson-White electrocardiographic pattern. Circ Arrhythm Electrophysiol 2014; 7(2): 218-23.
[http://dx.doi.org/10.1161/CIRCEP.113.000930] [PMID: 24488978]
[28]
Wellens HJ, Brugada P, Roy D, Weiss J, Bar FW. Effect of isoproterenol on the anterograde refractory period of the accessory pathway in patients with the WPW syndrome. Am J Cardiol 1981; 50(1): 180-4.
[http://dx.doi.org/10.1016/0002-9149(82)90026-1] [PMID: 7090999]
[29]
Page RL, Joglar JA, Caldwell MA, et al. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the heart rhythm society. Circulation 2016; 133(14): e506-74.
[http://dx.doi.org/10.1161/CIR.0000000000000311] [PMID: 26399663]
[30]
Ebenroth ES, Cordes TM, Darragh RK. Second-line treatment of fetal supraventricular tachycardia using flecainide acetate. Pediatr Cardiol 2001; 22(6): 483-7.
[http://dx.doi.org/10.1007/s002460010279] [PMID: 11894150]
[31]
Ferlini M, Colli AM, Bonanomi C, et al. Flecainide as first-line treatment for supraventricular tachycardia in newborns. J Cardiovasc Med (Hagerstown) 2009; 10(5): 372-5.
[http://dx.doi.org/10.2459/JCM.0b013e328329154d] [PMID: 19300276]
[32]
Perry JC, Garson A Jr. Flecainide acetate for treatment of tachyarrhythmias in children: review of world literature on efficacy, safety, and dosing. Am Heart J 1992; 124(6): 1614-21.
[http://dx.doi.org/10.1016/0002-8703(92)90081-6] [PMID: 1462922]
[33]
Di Mambro C, Russo MS, Righi D, et al. Ventricular pre-excitation: symptomatic and asymptomatic children have the same potential risk of sudden cardiac death. Europace 2015; 17(4): 617-21.
[http://dx.doi.org/10.1093/europace/euu191] [PMID: 25142741]


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VOLUME: 16
ISSUE: 2
Year: 2020
Page: [83 - 89]
Pages: 7
DOI: 10.2174/1573403X15666190301150754
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