title: Is exercise stress testing a cost-saving strategy for risk assessment of pediatric wolff-Parkinson-white syndrome patients?
abstract: BACKGROUND
  In Wolff-Parkinson-White syndrome (WPW) patients the loss of pre-excitation in a single heartbeat during exercise stress testing (EST) is a predictor of low risk of sudden death. The purpose of this study was to: 1) assess the frequency of loss of pre-excitation in a single heartbeat during exercise testing, and 2) compare the cost of EST versus trans-catheter electrophysiology study (EPS) in the risk assessment of WPW patients.
  
  
  METHODS
  A retrospective review of 50 cases of patients with WPW who underwent EST was conducted including demographics, history of supraventricular tachycardia, associated congenital heart disease, maximum heart rate achieved, and loss of pre-excitation in a single heartbeat. Hospital costs of EST and EPS were compared.
  
  
  RESULTS
  Of the 50 patients who underwent EST, 4 (8%), lost pre-excitation in a single heartbeat during EST. No differences were found regarding gender, age at diagnosis or EST, history of supraventricular tachycardia, presence of congenital heart disease or maximal heart rate. A cost comparison, utilizing the cost data: EST ($62.75) and EPS ($5,597) found EST to be a cost-saving approach in WPW patients. With 4 patients losing pre-excitation during EST, the cost saving of EST was $22,388 for this population of WPW patients.
  
  
  CONCLUSIONS
  A frequency of 8% loss of pre-excitation was found in a pediatric sample that underwent EST. Additionally, EST was shown to be a cost-saving strategy in risk assessment of pediatric WPW patients.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Moltedo
authors.forename: Ramesh V
authors.initials: RV
authors.lastname: Iyer
authors.forename: Howard
authors.initials: H
authors.lastname: Forman
authors.forename: John
authors.initials: J
authors.lastname: Fahey
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Rosenthal
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Snyder