title: Sports Eligibility After Risk Assessment and Treatment in Children with Asymptomatic Ventricular Pre-excitation.
abstract: OBJECTIVE
  Many studies concern the management of young patients with symptomatic Wolff-Parkinson-White (WPW) syndrome, but little information exists on the significance and prognosis of ventricular pre-excitation (VPE) in asymptomatic children. The aim of the study was to evaluate the risk of sudden death in young athletes with asymptomatic VPE by transesophageal electrophysiological study (TEEPS) and their sports eligibility after the risk assessment and/or ablative treatment.
  
  
  METHODS
  Ninety-one asymptomatic children and adolescents underwent TEEPS both at rest and during adrenergic stress (exercise testing or isoproterenol infusion). After electrophysiological testing, patients were assessed in the 36 months of follow-up.
  
  
  RESULTS
  Thirty-three patients (36.3 %) had a benign form of VPE and were allowed to participate in competitions. Ten patients (11 %) were at borderline risk; thus, sport eligibility was evaluated individually. Forty-eight patients (52.7 %) showed inducible sustained atrioventricular reentrant tachycardia and/or atrial fibrillation (AF), 11 of whom (12.1 % of total population) had a potential risk of sudden cardiac death due to AF inducibility during physical stress. Forty-five young athletes underwent transcatheter ablation (TCA). TCA was interrupted in 12 patients (26.7 %) because of the high procedural risk linked to septal accessory pathway (AP) location. There were no TCA-related complications, and all patients remained asymptomatic during follow-up.
  
  
  CONCLUSIONS
  Most of the young athletes with asymptomatic VPE may be allowed to participate in competitive sports after an adequate risk assessment and/or ablative treatment. However, in our opinion, special care should be taken to avoid procedural complications, which are unacceptable in asymptomatic patients.
authors.affiliation: Complex Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Via Torre di Palidoro, 00050, Fiumicino, Rome, Italy. corrado.dimambro@libero.it.
authors.forename: Corrado
authors.initials: C
authors.lastname: Di Mambro
authors.affiliation: Complex Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Via Torre di Palidoro, 00050, Fiumicino, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Drago
authors.affiliation: Complex Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Via Torre di Palidoro, 00050, Fiumicino, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Milioni
authors.affiliation: Complex Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Via Torre di Palidoro, 00050, Fiumicino, Rome, Italy.
authors.forename: M S
authors.initials: MS
authors.lastname: Russo
authors.affiliation: Complex Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Via Torre di Palidoro, 00050, Fiumicino, Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Righi
authors.affiliation: Complex Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Via Torre di Palidoro, 00050, Fiumicino, Rome, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Placidi
authors.affiliation: Complex Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Via Torre di Palidoro, 00050, Fiumicino, Rome, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Remoli
authors.affiliation: Complex Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Via Torre di Palidoro, 00050, Fiumicino, Rome, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Palmieri
authors.affiliation: Complex Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Via Torre di Palidoro, 00050, Fiumicino, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Gimigliano
authors.affiliation: Complex Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Via Torre di Palidoro, 00050, Fiumicino, Rome, Italy.
authors.forename: L M
authors.initials: LM
authors.lastname: Santucci
authors.affiliation: Complex Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Via Torre di Palidoro, 00050, Fiumicino, Rome, Italy.
authors.forename: M S
authors.initials: MS
authors.lastname: Silvetti
authors.affiliation: Complex Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Via Torre di Palidoro, 00050, Fiumicino, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Prosperi
mesh_terms: D000293:Adolescent; D058070:Asymptomatic Diseases; D017115:Catheter Ablation; D002648:Child; D016757:Death, Sudden, Cardiac / Q000209:etiology; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D011226:Pre-Excitation Syndromes / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D018570:Risk Assessment; D013177:Sports
references.citation: J Am Coll Cardiol. 2009 Jan 20;53(3):275-80
references.pmid: 19147045
references.citation: Am J Cardiol. 1982 Jul;50(1):180-4
references.pmid: 7090999
references.citation: Heart Rhythm. 2012 Jun;9(6):1006-24
references.pmid: 22579340
references.citation: Am J Cardiol. 2012 Apr 1;109(7):1011-4
references.pmid: 22221954
references.citation: Circulation. 2009 Mar 3;119(8):1085-92
references.pmid: 19221222
references.citation: Am J Cardiol. 1985 Apr 1;55(8):1001-4
references.pmid: 3984857
references.citation: J Cardiovasc Electrophysiol. 2004 Jul;15(7):759-70
references.pmid: 15250858
references.citation: Eur Heart J. 2005 Mar;26(5):516-24
references.pmid: 15689345
references.citation: Am J Cardiol. 1995 Sep 1;76(7):492-4
references.pmid: 7653450
references.citation: Circulation. 2012 May 15;125(19):2308-15
references.pmid: 22532593
references.citation: J Cardiovasc Electrophysiol. 2002 Dec;13(12):1222-6
references.pmid: 12521337
references.citation: Circ Arrhythm Electrophysiol. 2014 Apr;7(2):218-23
references.pmid: 24488978
references.citation: Circulation. 2014 Sep 2;130(10):811-9
references.pmid: 25052405
references.citation: Am J Cardiol. 1994 Aug 15;74(4):400-1
references.pmid: 8059708
references.citation: J Am Coll Cardiol. 2003 Dec 3;42(11):1959-63
references.pmid: 14662259
references.citation: Circulation. 1993 Mar;87(3):866-73
references.pmid: 8443907
references.citation: Am Heart J. 1996 Aug;132(2 Pt 1):280-5
references.pmid: 8701888
references.citation: Europace. 2013 Nov;15(11):1651-6
references.pmid: 23673973
references.citation: Circulation. 1962 Jun;25:947-61
references.pmid: 13907778
references.citation: Europace. 2015 Jun;17(6):946-52
references.pmid: 25600768
references.citation: J Am Coll Cardiol. 1985 Jan;5(1):130-5
references.pmid: 3964800
references.citation: N Engl J Med. 1979 Nov 15;301(20):1080-5
references.pmid: 492252
references.citation: J Interv Card Electrophysiol. 2006 Sep;16(3):191-8
references.pmid: 17031579
references.citation: Ann Med Interne (Paris). 1985;136(6):474-8
references.pmid: 4083638
references.citation: J Cardiovasc Electrophysiol. 1995 Mar;6(3):170-3
references.pmid: 7620642
references.citation: Pacing Clin Electrophysiol. 2004 Feb;27(2):235-9
references.pmid: 14764177
references.citation: J Electrocardiol. 2002;35 Suppl:143-9
references.pmid: 12539112
references.citation: Europace. 2007 Sep;9(9):837-43
references.pmid: 17670785
references.citation: J Am Coll Cardiol. 2003 Jan 15;41(2):239-44
references.pmid: 12535816
references.citation: Int J Cardiol. 2005 Feb 15;98(2):207-14
references.pmid: 15686769
references.citation: Pacing Clin Electrophysiol. 1988 Aug;11(8):1130-8
references.pmid: 2459665
references.citation: Europace. 2015 Apr;17(4):617-21
references.pmid: 25142741
references.citation: J Cardiovasc Electrophysiol. 1998 Aug;9(8 Suppl):S63-8
references.pmid: 9727678
references.citation: Pediatrics. 2012 Apr;129(4):e999-1010
references.pmid: 22392183
references.citation: Circulation. 1989 Dec;80(6):1902-5
references.pmid: 2486558