Clinical and electrophysiologic evolution of the Wolff-Parkinson-White syndrome in children: impact on approaches to management

There is less certainty about the recommendations for radio-frequency ablat ion as a therapeutic option for Wolff-Parkinson-White syndrome in children as opposed to adults because of the different natural history and the age-r elated risks of ablation. To help decision-making, we evaluated the long te rm clinical evolution and electrophysiologic characteristics of pre-excitat ion in our series of children and young adults. We reviewed the clinical co urse of 109 patients below the age of 18 years who had been followed up ove r a period of 9+4 years, with a range from one to 27 years. This correspond ed to 986 patient-years. We examined also the electrophysiologic data from 98 of those patients who underwent a transesophageal study. At the discovery of pre-excitation, 59% of patients were asymptomatic, whil e 29% developed supraventricular tachycardia during follow-up. The peak inc idence of the onset of supraventricular tachycardia occurred during infancy . These patients had the highest incidence of subsequent spontaneous disapp earance of the tachycardia (53%), such a favourable evolution being encount ered in only 12% of patients in whom the abnormal rhythm first appeared aft er 12 years of age. Chronic medical treatment was required in 47% of patien ts, and proved completely effective in 45% of cases. The potential to induc e atrial fibrillation, and the incidence pre-excitation considered to be hi gh risk, with the shortest pre-excited RR interval equal to or less than 22 0msec, was lowest in the group of patients aged less than 6 years of age, a nd highest in those older than 12 years of age (p < 0.001). Pathways produc ing arrhythmia with high risk were more common in symptomatic (29%) than in asymptomatic patients (7%) (p < 0.001). No mortality occurred. On the basi s of our findings, we suggest that ablation should be avoided before: the a ge of 5 or 6 years. Thereafter, the procedure should become the first line of treatment for symptomatic patients older than 12 years of age.