Clinical and electrophysiologic characteristics of antidromic tachycardia in children with Wolff-Parkinson-White syndrome.
BACKGROUND
Antidromic reciprocating tachycardia (ART) is a rare form of wide complex tachycardia in children with Wolff-Parkinson-White syndrome (WPW). The incidence and electrophysiologic characteristics of ART in children with WPW have not been well described.


METHODS
A multicenter retrospective analysis of all patients with WPW undergoing electrophysiology (EP) study from 1990 to 2009 was performed. Patients with clinical or inducible ART were included.


RESULTS
A total of 1,147 patients with WPW underwent EP study and 30 patients had ART (2.6%) and were the subject of this analysis. The mean age was 16±3 years, weight was 65±16 kg, and tachycardia cycle length was 305±55 ms. There were two patients (7%) with congenital heart disease (both with Ebstein's anomaly). Four patients (13%) had more than one accessory pathway (AP). The location of the AP was left sided in 53% of patients and right sided in 47%, with septal location and left lateral pathways most commonly involved. AP conduction was found to be high risk in 17 patients (57%). Ablation was not attempted in two patients (7%) due to proximity to the HIS and risk of heart block. Ablation was acutely successful in 93% of the patients in whom it was attempted.


CONCLUSIONS
ART is a rare finding in children undergoing EP study. Over half of the patients with ART were found to be high risk and multiple AP were uncommon. Unlike the adult population, ART occurred commonly with septal APs.
Pediatric Arrhythmia Service, Division of Pediatric Cardiology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York 10467-2490, USA. sceresna@montefiore.org
Scott R
SR
Ceresnak
Ronn E
RE
Tanel
Robert H
RH
Pass
Leonardo
L
Liberman
Kathryn K
KK
Collins
George F
GF
Van Hare
Gregory J
GJ
Gates
Anne M
AM
Dubin
D000293:Adolescent; D017115:Catheter Ablation; D004568:Electrodiagnosis / Q000379:methods; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D054139:Tachycardia, Reciprocating / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome; D014927:Wolff-Parkinson-White Syndrome / Q000503:physiopathology* / Q000601:surgery; D055815:Young Adult