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Asymptomatic ventricular pre-excitation in children and adolescents: a 15 year follow up study
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  1. B Sarubbi,
  2. G Scognamiglio,
  3. G Limongelli,
  4. B Mercurio,
  5. G Pacileo,
  6. C Pisacane,
  7. M G Russo,
  8. R Calabrò
  1. Second University of Naples, Chair of Cardiology, Division of Pediatric Cardiology, Monaldi Hospital Naples, Italy
  1. Correspondence to:
    Dr Berardo Sarubbi, Via Tino di Camaino, 23 80128 Napoli, Italy;
    bsarubb{at}tin.it

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The term Wolff-Parkinson-White (WPW) syndrome refers to people with a ventricular pre-excitation (VPE) pattern on ECG who experience symptomatic bouts of tachycardia.1 Asymptomatic patients with VPE are better described as simply having a “VPE pattern”.

Diagnostic assessment and treatment have been described in detail in patients with symptomatic WPW syndrome, but little information exists about the prognosis of VPE discovered on routine ECG in an asymptomatic person.

Our study aimed to examine retrospectively the follow up of a cohort of children with asymptomatic VPE, referred during a 15 year period to our unit.

METHODS

From January 1985 to July 2001, 98 children (56 male/42 female) found incidentally to have a VPE on routine ECG were referred to our division. All patients underwent a complete evaluation. The patients were considered asymptomatic if they had no documented tachycardia and no history of palpitations. At recruitment, all the patients underwent clinical examination, ECG, echocardiogram, ECG Holter, and, when possible, exercise testing. Accessory pathway location was established by the use of ECG criteria according to Fitzpatrick’s algorithm.2 The start of the follow up period dated from the time when the first ECG with a δ wave was recorded.

Intermittence of VPE was defined as reappearance after loss. Loss of VPE was defined as the absence of VPE for more than three consecutive controls.

In the absence of symptoms, patients were seen in outpatient clinic at 6–12 month intervals.

Electrophysiological study (EPS)

The shortest cycle length showing pre-excitation was designated as the minimal cycle length that maintained 1:1 conduction over the accessory pathway. Programmed atrial stimulation at a basic cycle length of 600, 500, and 400 ms with the introduction of one and two extrastimuli was performed. The effective refractory period of the accessory pathway was the longest A1–A2 interval without VPE. If atrial fibrillation (AF) was …

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