Electro Physiological Study and Ablation in Children with Asymptomatic Wolff-Parkinson-White Syndrome

Purpose: Asymptomatic WPW syndrome is defined as an isolated ventricular pre-excitation without arrhythmia symptoms or documented atrio-ventricular reentry tachycardia AVRT. Induction of AVRT, a shortest pre-excited RR interval (SPRRI) during AF and/or an AP effective refractory period (APERP) of less than 240 ms, the presence of multiple pathways, septal and right-sided pathway and younger age may identify a high risk group. Recently, an Expert Consensus Statement on the Management of the Asymptomatic Young Patient with WPW was published. We routinely offer an EPS for asymptomatic children with WPW syndrome; it happens that this policy is in complying with recently published recommendations. In this work we would like to describe our experience in this group of patients. Methods: Invasive EPS were performed in 142 (111 boys and 31 girls) asymptomatic children aged 5 to 19 years old (12.8±3.5) with WPW. Children with high risk for SCD (SPRRI during AF and/or APERP < 240 ms) or inducible AVRT or both underwent ablation of the AP. Results: Seventy eight out of 142 (55%) children had a negative EPS, the rest of children 64 (45%) reached the high risk criteria or inducible AVRT or both. Among them 60/64 (93.5%) had successful ablation of the AP. The fluoroscopy time for the ablated children was 30.9±21.3 compared to 3.5±2.7 min for non-ablated children. The ablated AP were located to the left side in 20/64 (31%), para-Hisian, anteroseptal or midseptal in 13 (20.5%), right posterior in 23 (36%) and right lateral in 8 (12.5%) children. Eight children had cryoablation, the rest had RFA. One patient had transient atrio-ventricular block during cryomapping. Conclusions: About half of "asymptomatic WPW" children had high risk criteria for SCD and/or AVRT. EPS and ablation of this population is safe and highly successful and compatible with the recently published expert consensus statement.