Difficulties with invasive risk stratification performed under anesthesia in pediatric Wolff-Parkinson-White Syndrome

Mark H Shwayder; Carolina A Escudero; Susan P Etheridge; Brynn E Dechert; Ian H Law; Andrew D Blaufox; James C Perry; Anne M Dubin; Shubhayan Sanatani; Kathryn K Collins

doi:10.1016/j.hrthm.2019.09.011

Difficulties with invasive risk stratification performed under anesthesia in pediatric Wolff-Parkinson-White Syndrome

Heart Rhythm. 2020 Feb;17(2):282-286. doi: 10.1016/j.hrthm.2019.09.011. Epub 2019 Sep 12.

Authors

Affiliations

¹ Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah.
² Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital and University of Alberta, Edmonton, AB, Canada.
³ Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.
⁴ Division of Pediatric Cardiology, Department of Pediatrics, University of Iowa Hospital and Clinics, Iowa City, Iowa.
⁵ Department of Pediatric Cardiology, Cohen Children's Medical Center of New York, New Hyde Park, New York.
⁶ Division of Cardiology, Department of Pediatrics, University of California San Diego-Rady Children's Hospital, San Diego, California.
⁷ Division of Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Palo Alto, California.
⁸ Division of Cardiology, Department of Pediatrics, British Colombia Children's Hospital, Vancouver, BC, Canada.
⁹ Division of Cardiology, Department of Pediatrics, Children's Hospital of Colorado, Aurora, Colorado. Electronic address: kathryn.collins@childrenscolorado.org.

PMID: 31521806
DOI: 10.1016/j.hrthm.2019.09.011

Abstract

Background: Children with Wolff-Parkinson-White Syndrome (WPW) are at risk for sudden death. The gold standard for risk stratification in this population is the shortest pre-excited RR interval during atrial fibrillation (SPERRI).

Objective: The purpose of this study was to determine how closely measurements made in the electrophysiology laboratory in patients with WPW compared to SPERRI obtained during an episode of clinical pre-excited atrial fibrillation (Clinical-SPERRI).

Methods: This was a subgroup analysis of a multicenter study of children with WPW. Subjects in our study (N = 49) were included if they had Clinical-SPERRI measured in addition to 1 or more of 3 surrogate measurements: SPERRI obtained during electrophysiological study (EP-SPERRI), accessory pathway effective refractory period (APERP), or shortest pre-excited paced cycle length with 1:1 conduction (SPPCL).

Results: Seventy percent of electrophysiological measurements were made with patients under general anesthesia. Clinical-SPERRI moderately correlated with EP-SPERRI (r = 0.495; P = .012). However, 24% of our patients with Clinical-SPERRI ≤250 ms would have been misclassified as having a low-risk pathway based on EP-SPERRI >250 ms. Clinical-SPERRI did not correlate with APERP or SPPCL (r < 0.3; P >.1). Mean EP-SPERRI, APERP, and SPPCL all were greater than Clinical-SPERRI.

Conclusion: Electrophysiology laboratory measurements of pathway characteristics made with patients under general anesthesia do not correlate well with Clinical-SPERRI. Of APERP, SPPCL, and EP-SPERRI, only EP-SPERRI had moderate correlation with Clinical-SPERRI. This study questions the predictive ability of invasive risk stratification with patients under general anesthesia, given that 24% of patients with high-risk Clinical-SPERRI (≤250 ms) had EP-SPERRI that may be considered low risk (>250 ms).

Keywords: Arrhythmia; Electrophysiology; Pediatrics; Sudden cardiac death; Wolff-Parkinson-White syndrome.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Anesthesia / methods*
Child
Electrophysiologic Techniques, Cardiac / methods*
Female
Follow-Up Studies
Heart Conduction System / physiopathology*
Heart Rate / physiology*
Humans
Male
Retrospective Studies
Risk Assessment / methods*
Wolff-Parkinson-White Syndrome / physiopathology*