Atrial fibrillation induction by transesophageal electrophysiology studies in patients with asymptomatic ventricular preexcitation.
OBJECTIVE
Ventricular preexcitation is a conduction abnormality caused by an accessory pathway bridging the atria and ventricles. If the accessory pathway conducts rapidly during atrial fibrillation (AFib), sudden death may result. The purpose of this study was to determine the ability of transesophageal electrophysiology studies (TEEPS) to induce AFib in pediatric patients with asymptomatic ventricular preexcitation (aVPE).


METHODS
A retrospective review of patients with aVPE who had a TEEPS was conducted. Inclusion criteria were evidence of ventricular preexcitation on electrocardiogram; age <18 years; and no history of tachycardia, palpitations, or syncope. Data gathered included age, weight, height, form of sedation, and TEEPS results. If AFib was induced, patients were classified as at risk of sudden death if the shortest preexcited RR interval during AFib was <250 ms or no risk if ≥ 250 ms.


RESULTS
A total of 26 patients met the inclusion criteria, with average age of 11.9 years, weight of 48.9 kg, and height of 149.2 cm. During the procedure, nine patients underwent conscious sedation (34.6%), and 17 underwent general anesthesia (65.4%). AFib was induced in 23 patients (88.5%), of whom 17 (73.9%) had no risk and six (26.1%) had risk. No statistical differences were noted in age, weight, height, or form of sedation when comparisons were made between AFib induction and no AFib induction.


CONCLUSIONS
TEEPS induced AFib in 88.5% of patients. Age, weight, height, and form of sedation had no effect upon AFib inducibility. TEEPS is an effective modality to induce AFib in pediatric patients with aVPE.
Department of Pediatrics, Tulane University, New Orleans, LA, USA.
Walter J
WJ
Hoyt
Patricia E
PE
Thomas
Holly C
HC
DeSena
Joan S
JS
Steinberg
Donald E
DE
Harmon
Christopher S
CS
Snyder
D000293:Adolescent; D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D011226:Pre-Excitation Syndromes / Q000150:complications / Q000503:physiopathology*; D012189:Retrospective Studies; D018570:Risk Assessment