Evaluation and treatment of other arrhythmic causes of syncope in children and adolescents with an apparently normal heart: Wolff-Parkinson-White syndrome and right ventricular cardiomyopathy.
Syncope could be a symptom of tachyarrhythmias related to the Wolff-Parkinson-White syndrome, or the consequence of the ventricular tachycardias seen in patients with Arrhythmogenic Right Ventricular Cardiomyopathy. Syncope should be considered the consequence of atrial fibrillation or flutter, with rapid conduction over the accessory atrioventricular connection in Wolff-Parkinson-White syndrome, and these patients are at risk of presenting with ventricular fibrillation and sudden death. Radiofrequency ablation of the anomalous, accessory connection, which can be performed with high success and low complication rates, should be the first line of treatment for symptomatic children and adolescents with Wolff-Parkinson-White. Arrhythmogenic Right Ventricular Cardiomyopathy is a rare disorder of the cardiac muscle affecting predominantly, although not exclusively, the right ventricle. Clinical presentation varies from asymptomatic cases to patients with severe symptoms related to life-threatening arrhythmias, right ventricular failure, or congestive heart failure with involvement of both ventricles. The clinical diagnosis is difficult. A set of major and minor criteria has been proposed to help to identify patients with this disease. Without an identified cause, the treatment of patients with Arrhythmogenic Right Ventricular Cardiomyopathy is symptomatic. Medical management of the associated congestive heart failure, pharmacologic treatment of the arrhythmias, radiofrequency ablation and implantable cardioverter-defibrillator therapy should all be considered.
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