Radiofrequency ablation in children with asymptomatic Wolff-Parkinson-White syndrome
Open accessAbstract
BACKGROUND: Ventricular fibrillation can be the presenting arrhythmia in children with asymptomatic Wolff-Parkinson-White syndrome. Deaths due to this arrhythmia are potentially preventable. METHODS: We performed a randomized study in which prophylactic radiofrequency catheter ablation of accessory pathways was compared with no ablation in asymptomatic children (age range, 5 to 12 years) with the Wolff-Parkinson-White syndrome who were at high risk for arrhythmias. The primary end point was the occurrence of arrhythmic events during follow-up. RESULTS: Of the 165 eligible children, 60 were determined to be at high risk for arrhythmias. After randomization, but before any ablation had been performed, the parents withdrew 13 children from the study. Of the remaining children, 20 underwent prophylactic ablation and 27 had no treatment. The characteristics of the two groups were similar. There were three ablation-related complications, one of which led to hospitalization. During follow-up, 1 child in the ablation group (5 percent) and 12 in the control group (44 percent) had arrhythmic events. Two children in the control group had ventricular fibrillation, and one died suddenly. The cumulative rate of arrhythmic events was lower among children at high risk who underwent ablation than among those at high risk who did not. The reduction in risk associated with ablation remained significant after adjustment in a Cox regression analysis. In both the ablation and the control groups, the independent predictors of arrhythmic events were the absence of prophylactic ablation and the presence of multiple accessory pathways. CONCLUSIONS: In asymptomatic, high-risk children with the Wolff-Parkinson-White syndrome, prophylactic catheter ablation performed by an experienced operator reduces the risk of life-threatening arrhythmias.
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In that second study, the cumulative rate of arrhythmic events was lower among high-risk children who underwent ablation than among those who did not, and the reduction remained significant after adjustment in a Cox regression analysis.
“The cumulative rate of arrhythmic events was lower among children at high risk who underwent ablation than among those at high risk who did not.The reduction in risk associated with ablation remained significant after adjustment in a Cox regression analysis.”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [345]
In that second study, during follow-up, 1 child in the ablation group (5%) and 12 in the control group (44%) had arrhythmic events; two control children had VF and one died suddenly.
“During follow-up, 1 child in the ablation group (5%), and 12 in the control group (44%) had arrhythmic events.Two children in the control group had ventricular fibrillation, and one died suddenly.”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [345]
In the second randomized study of asymptomatic children (age 5-12) with WPW and inducible AVRT or AF, after randomization of 60 children, parents withdrew 13; of the remaining, 20 underwent prophylactic ablation and 27 had no treatment.
“The second randomized study was conducted on asymptomatic children (age range, 5 to 12 years) with WPW syndrome and in whom AVRT or AF were reproducibly inducible.After randomization of 60 children, but before any ablation had been performed, the parents withdrew 13 of them from the study.Of the remaining children, 20 underwent prophylactic ablation and 27 had no treatment.”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [345]
In that second study, respiratory arrest and femoral vein thrombosis were seen in two patients, while ablation-related complications were seen in three patients (RBBB, transient AV block and pericardial effusion).
“Respiratory arrest and femoral vein thrombosis were seen in two patients, while ablation-related complications were seen in three patients (RBBB, transient AV block and pericardial effusion).345”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [345]
In that second study, independent predictors of arrhythmic events were the absence of prophylactic ablation and the presence of multiple accessory pathways.
“In both ablation and control groups, the independent predictors of arrhythmic events were the absence of prophylactic ablation and the presence of multiple accessory pathways.”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [345]
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- Authors
- Pappone, C., Manguso, F., Santinelli, R., Vicedomini, G., Sala, S., Paglino, G., Mazzone, P., Lang, C. C., Gulletta, S., Augello, G., Santinelli, O., & Santinelli, V.
- Affiliations
- IRCCS Ospedale San Raffaele (IT)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2004-09-16
- Volume
- 351
- Issue
- 12
- Pages
- 1197-1205
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2082183477
- Cited by
- 214
- References
- 24
- Citations by year
- 2026: 6 · 2024: 3 · 2023: 3 · 2022: 4 · 2021: 5 · 2020: 7 · 2019: 9 · 2018: 9 · 2017: 6 · 2016: 5 · 2015: 20 · 2014: 8 · 2013: 12 · 2012: 18
- FWCI
- 9.15
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- INFM-OAR (INFN Catania) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Keywords
- Wolff-Parkinson-White syndrome, accessory pathway, ventricular fibrillation, sudden cardiac death, arrhythmic events, children, multiple accessory pathways, arrhythmia risk
- MeSH terms
- Arrhythmias, Cardiac, Child, Child, Preschool, Female, Follow-Up Studies, Heart Conduction System, Humans, Male, Postoperative Complications, Risk Factors, Ventricular Fibrillation, Wolff-Parkinson-White Syndrome, Proportional Hazards Models, Death, Sudden, Cardiac, Catheter Ablation, Disease-Free Survival, Electrophysiologic Techniques, Cardiac
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