Abstract
Surrogates for the shortest pre-excited R-R interval in atrial fibrillation (SPERRI) such as the accessory pathway effective refractory period (APERP) and shortest pre-excited paced cycle length (SPPCL) are flawed assessments of accessory pathway function in patients with WPW. Multi-extrastimulus pacing may have the theoretical advantage of more accurately mimicking the clinical reality of atrial fibrillation and thus may serve to better assess accessory pathway function. This cross-sectional study included 25 consecutive patients, aged ≤ 18 years, undergoing electrophysiology study for WPW. The longest S1S2, S2S3, S3S4 coupling intervals at which the antegrade AP refractoriness occurred, SPERRI, and SPPCL were recorded. Induction of atrial fibrillation was attempted in all patients and induced in 8 (32%, 4 SPERRIbaseline (265 ms ± 61 ms), 4 SPERRIIsuprel (258 ms ± 41 ms)). At baseline, the lower value of the S3ERP or S4ERP (274 ms ± 52 ms) was lower than the SPPCL (296 ms ± 54 ms, p < 0.0001) and APERP (296 ms ± 41 ms, p < 0.0001). More patients had S3ERP or S4ERP ≤ 250 ms (12/25, 48%) compared to those with APERP ≤ 250 ms (2/25 8%), p = 0.0016), SPPCL 5/24, 20%), p = 0.008 or either (6/25, 24%), p = 0.0143). With Isuprel, the lower value of the S3ERP or S4ERP (221 ms ± 36 ms) trended to be lower than the APERP (252 ms ± 36 ms, p = 0.0001) and the SPPCL (266 ms ± 57 ms, p = 0.001). With Isuprel, there was no statistical difference in the proportion of patients with S3ERP or S4ERP < 250 ms (12/16, 75%) compared to those with APERP ≤ 250 ms ((9/16, 56%), p = 0.08), SPPCL ≤ 250 ms ((9/16, 56%), p = 0.08), or either ((10/16, 63%), p = 0.16). Multi-extrastimulus pacing protocols demonstrate that accessory pathways are less refractory than as defined by single extrastimulus pacing and straight decremental pacing.
Similar content being viewed by others
References
Cannon BC, Davis AM, Drago F, Janousek J, Klein GJ, Law IH, Morady FJ et al (2012) PACES/HRS expert consensus statement on the management of the asymptomatic young patient with a Wolff-Parkinson-White (WPW, ventricular preexcitation) electrocardiographic pattern. Pediatr Congenit Electrophysiol Soc Heart Rhythm Soc 9(6):1006–1024
Russell MWDP, Dick MD (1993) Incidence of catastrophic events associated with the Wolff-Parkinson-White syndrome in young patients: diagnostic and therapeutic dilemma. Circulation 1993:484
Pappone C, Vicedomini G, Manguso F et al (2014) Wolff-Parkinson-White syndrome in the era of catheter ablation: insights from a registry study of 2169 patients. Circulation 130:811–819
Klein GJ, Bashore TM, Sellers TD, Pritchett EL, Smith WM, Gallagher JJ (1979) Ventricular fibrillation in the Wolf-Parkinson-White syndrome. N Engl J Med 301:1080–1085
Pappone C, Santinelli V, Rosanio S, Vicedomini G, Nardi S, Pappone A, Tortoriello V, Manguso F, Mazzone P, Gulletta S et al (2003) Usefulness of invasive electrophysiologic testing to stratify the risk of arrhythmic events in asymptomatic patients with Wolf-Parkinson White pattern; results from a large prospective long-term follow up study. J Am Coll Cardiol 41:239–244
Etheridge S, Escudero C, Blaufox A et al (2017) Life threatening event risk in children with Wolff Parkinson white syndrome. A multicenter institutional study. JACC Clin Electrophysiol 9:1–10
Dubin AM et al (2019) What have we learned in the last 20 years? A comparison of a modern era pediatric and congenital catheter ablation registry to previous pediatric ablation registries. Heart Rhythm Soc 16:57–63
Josephson EM (2003) Recurrent ventricular tachycardia. In: Josephson ME (ed) Clinical cardiac electrophysiology: techniques and interpretations. Williams & Wilkins, Philadelphia, pp 425–610
Al-Ammouri I, Perry JC (2006) Proximity of coronary arteries to the atrioventricular valve annulus in young patients and implications for ablation procedures. Am J Cardiol 97(12):1752–1755. https://doi.org/10.1016/j.amjcard.2006.01.037
Schneider HE et al (2009) Incidence of coronary artery injury immediately after catheter ablation for supraventricular tachycardias in infants and children. Heart Rhythm 6(4):461–467. https://doi.org/10.1016/j.hrthm.2009.01.029
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Rigos, L.J., Fishbein, J.S. & Blaufox, A.D. Novel Assessment of Accessory Pathway Function in Patients with Wolff–Parkinson–White Syndrome. Pediatr Cardiol 41, 1212–1219 (2020). https://doi.org/10.1007/s00246-020-02377-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-020-02377-0