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Non-invasive Risk Stratification in Pediatric Ventricular Pre-excitation

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Abstract

Children with ventricular pre-excitation are at risk for sudden death. This retrospective pediatric study identified patients > 8 years of age who had undergone electrophysiology study (EPS). Our primary objective was to determine the performance characteristics of non-invasive risk stratification. Subjects were separated into two groups. Group 1 was asymptomatic or had non-specific symptoms (palpitations, chest pain, and light headedness) without documented supraventricular tachycardia (SVT). Group 2 had syncope, documented SVT, or a life-threatening event. As a secondary aim, we tested whether patients with severe symptoms had a shorter time from the date of diagnosis to the date of invasive risk stratification. Among 93 patients with an average age of 14.2 years, 25 patients had documented SVT, 6 had syncope, and 1 had a life-threatening event. The sensitivity of non-invasive risk stratification was 7%. The specificity was 91%. The positive predictive valve was 14% and the negative predictive value was 84%. Even patients with severe symptoms commonly underwent non-invasive risk stratification prior to EPS, albeit at a lower rate (Group 1, 98%; Group 2 84%, p = 0.02). The median time to EPS was 4.2 months (Group 1) and 4.5 months (Group 2, p = 0.63). Non-invasive risk stratification was a poor predictor of invasive risk stratification. Cardiologists should counsel families about the limitations of non-invasive risk stratification and consider starting with invasive risk stratification and possible ablation. Counterintuitively, severe symptoms were not associated with a shorter time to electrophysiology study.

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Funding

The study was funded, in part, by the National Institutes of Health, National Heart, Lung and Blood Institute (Grant No. K23HL130554). REDCap access was provided by Northwestern University Clinical and Translational Sciences Institute (Grant No. NIH UL1TR001422).

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Authors and Affiliations

  1. Division of Cardiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 21, Chicago, IL, 60611, USA

    Rana Khaznadar, Stephanie F. Chandler, A. Sami Chaouki, Sabrina Tsao & Gregory Webster

Authors
  1. Rana Khaznadar
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  2. Stephanie F. Chandler
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  3. A. Sami Chaouki
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  4. Sabrina Tsao
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  5. Gregory Webster
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection were performed by Rana Khaznadar and Sami Chaouki. Invasive data collection and analysis were performed by Stephanie Chandler, Sami Chaouki, Sabrina Tsao, and Greg Webster. The first draft of the manuscript was written by Rana Khaznadar and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Gregory Webster.

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Research Involving Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Khaznadar, R., Chandler, S.F., Chaouki, A.S. et al. Non-invasive Risk Stratification in Pediatric Ventricular Pre-excitation. Pediatr Cardiol 41, 709–715 (2020). https://doi.org/10.1007/s00246-020-02285-3

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  • DOI: https://doi.org/10.1007/s00246-020-02285-3

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