G. Vignati et al., Clinical and electrophysiologic evolution of the Wolff-Parkinson-White syndrome in children: impact on approaches to management, CARD YOUNG, 10(4), 2000, pp. 367-375
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.