title: Ventricular pre-excitation: symptomatic and asymptomatic children have the same potential risk of sudden cardiac death.
abstract: OBJECTIVE
  Children and adolescents with ventricular pre-excitation (VPE) are at increased risk for sudden cardiac death (SCD). Although antiarrhythmic therapy and catheter ablation are well established temporary or definitive treatments for patients with Wolff-Parkinson-White (WPW) syndrome, the optimal management of children with asymptomatic VPE remains to be clearly defined. On the basis of the most recent guidelines and recommendations, the aim of this study was to determine the electrophysiological characteristics of young patients with VPE and WPW syndrome to assess and compare their potential risk of SCD.
  
  
  RESULTS
  We retrospectively investigated 124 consecutive young patients with VPE (51 with WPW syndrome and 73 asymptomatic) who underwent transoesophageal electrophysiological study. At baseline, atrioventricular reentrant tachycardia (AVRT) was induced in 13 WPW vs. 10 asymptomatic patients (25.5 vs. 13.7%, P = NS). Atrial fibrillation (AF) was induced in 13 WPW vs. 15 asymptomatic patients (25.5 vs. 20.5%, P = NS). A shortest pre-excited R-R interval (SPERRI) ≤250 ms during AF was found in four WPW vs. six asymptomatic patients (30.8 vs. 40%, P = NS). During isoproterenol infusion or stress testing, AVRT was induced in 31 of 44 WPW vs. 33 of 69 asymptomatic patients (70.4 vs. 47.8%, P = 0.018). Atrial fibrillation was induced in 12 of 44 WPW vs. 21 of 69 asymptomatic patients (27.3 vs. 30.4%, P = NS). A SPERRI ≤ 210 ms was found in 6 of 12 WPW vs. 10 of 21 asymptomatic patients (50 vs. 47.6%, P = NS). No statistically significant correlation was observed between accessory pathway location and symptoms, AVRT/AF inducibility, or mean APERP/SPERRI values.
  
  
  CONCLUSIONS
  Children and adolescents with WPW syndrome have a higher rate of AVRT inducibility than asymptomatic patients. However, no differences between the two groups were found in atrial vulnerability and parameters related to the risk of SCD.
authors.affiliation: Paediatric Arrhythmia Unit and Syncope Unit, Department of Paediatric Cardiology, Bambino Gesù Children's Hospital, IRCCS, Via Torre di Palidoro snc, 00050 Palidoro-Fiumicino (Rome), Italy corrado.dimambro@libero.it.
authors.forename: Corrado
authors.initials: C
authors.lastname: Di Mambro
authors.affiliation: Paediatric Arrhythmia Unit and Syncope Unit, Department of Paediatric Cardiology, Bambino Gesù Children's Hospital, IRCCS, Via Torre di Palidoro snc, 00050 Palidoro-Fiumicino (Rome), Italy.
authors.forename: Mario Salvatore
authors.initials: MS
authors.lastname: Russo
authors.affiliation: Paediatric Arrhythmia Unit and Syncope Unit, Department of Paediatric Cardiology, Bambino Gesù Children's Hospital, IRCCS, Via Torre di Palidoro snc, 00050 Palidoro-Fiumicino (Rome), Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Righi
authors.affiliation: Paediatric Arrhythmia Unit and Syncope Unit, Department of Paediatric Cardiology, Bambino Gesù Children's Hospital, IRCCS, Via Torre di Palidoro snc, 00050 Palidoro-Fiumicino (Rome), Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Placidi
authors.affiliation: Paediatric Arrhythmia Unit and Syncope Unit, Department of Paediatric Cardiology, Bambino Gesù Children's Hospital, IRCCS, Via Torre di Palidoro snc, 00050 Palidoro-Fiumicino (Rome), Italy.
authors.forename: Rosalinda
authors.initials: R
authors.lastname: Palmieri
authors.affiliation: Paediatric Arrhythmia Unit and Syncope Unit, Department of Paediatric Cardiology, Bambino Gesù Children's Hospital, IRCCS, Via Torre di Palidoro snc, 00050 Palidoro-Fiumicino (Rome), Italy.
authors.forename: Massimo Stefano
authors.initials: MS
authors.lastname: Silvetti
authors.affiliation: Paediatric Arrhythmia Unit and Syncope Unit, Department of Paediatric Cardiology, Bambino Gesù Children's Hospital, IRCCS, Via Torre di Palidoro snc, 00050 Palidoro-Fiumicino (Rome), Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Gimigliano
authors.affiliation: Paediatric Arrhythmia Unit and Syncope Unit, Department of Paediatric Cardiology, Bambino Gesù Children's Hospital, IRCCS, Via Torre di Palidoro snc, 00050 Palidoro-Fiumicino (Rome), Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Prosperi
authors.affiliation: Paediatric Arrhythmia Unit and Syncope Unit, Department of Paediatric Cardiology, Bambino Gesù Children's Hospital, IRCCS, Via Torre di Palidoro snc, 00050 Palidoro-Fiumicino (Rome), Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Drago
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D022062:Electrophysiologic Techniques, Cardiac / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D018570:Risk Assessment; D015996:Survival Rate; D063189:Symptom Assessment / Q000706:statistics & numerical data; D014927:Wolff-Parkinson-White Syndrome / Q000175:diagnosis* / Q000401:mortality*
keywords: Paediatric age; Sudden cardiac death; Ventricular pre-excitation; WPW syndrome