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Pre-excitation cardiac problems in children: recognition and treatment

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Abstract

The prevalence of ventricular pre-excitation is 0.07–0.2% in the pediatric population. Kent bundle is the most common atrioventricular accessory pathway and Mahaim fiber is relatively rare. Approximately, 30–60% of children with ventricular pre-excitation have onset of atrioventricular reentrant tachycardia. Persistent atrioventricular reentrant tachycardia can lead to tachycardiomyopathy. The anterograde conduction of right accessory pathway might lead to ventricular systolic dyssynchrony which might result in cardiac dysfunction even in patients with no tachycardia onset. This type of dilated cardiomyopathy was named as accessory pathway-induced dilated cardiomyopathy. Antiarrhythmic drugs can be used to acutely terminate tachycardia or taken orally to decrease tachycardia recurrence in the long term. However, antiarrhythmic drugs that can be chosen for children are quite limited. Sotalol has become a new choice. With the maturation of radiofrequency catheter ablation technique, progress in three-dimensional electro-anatomic mapping, use of cryoablation, and accumulation of experience in children with small age and weight, catheter ablation has become the first choice for children with pre-excitation syndrome.

Conclusion: For ventricular pre-excitation co-exists with dilated cardiomyopathy, differential diagnosis of tachycardiomyopathy or accessory pathway-induced dilated cardiomyopathy should be considered. Catheter ablation (radiofrequency and cryoablation) is a relatively safe and effective treatment option and has become the first choice to treat children with ventricular pre-excitation.

What is Known:

• Persistent atrioventricular reentrant tachycardia in children can lead to tachycardiomyopathy;

• Antiarrhythmic drugs that can be chosen for children are quite limited.

What is New:

• The anterograde conduction of right accessory pathway (not related to supraventricular tachycardia) might lead to accessory pathway-induced dilated cardiomyopathy.

• Catheter ablation (including radiofrequency and cryoablation) has become the first choice for children with pre-excitation syndrome.

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Abbreviations

AP-induced DCM:

Accessory pathway-induced dilated cardiomyopathy

AVRT:

Atrioventricular reentrant tachycardia

CA:

Catheter ablation

EPS:

Electrophysiological study

RFCA:

Radiofrequency catheter ablation

SVT:

Supraventricular tachycardia

TCMP:

Tachycardiomyopathy

VPE:

Ventricular pre-excitation

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Acknowledgments

The authors thank Dr Zhang Yan for revising English writing.

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  1. Department of Pediatric Cardiology, Heart Center, the First Hospital of Tsinghua University (Beijing Huaxin Hospital), School of Clinical Medicine, Tsinghua University, No.6 Jiuxianqiao 1st Road, Chaoyang district, Beijing, 100016, China

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YZ performed the literature search and drafted the manuscript. XL revised the manuscript and gave the final approval.

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Zhang, Y., Li, Xm. Pre-excitation cardiac problems in children: recognition and treatment. Eur J Pediatr 179, 1197–1204 (2020). https://doi.org/10.1007/s00431-020-03701-9

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