| Clinical and electrophysiologic evolution of the Wolff-Parkinson-White syndrome in children: impact on approaches to management. | |
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MedLine Citation:
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PMID: 10950334 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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There is less certainty about the recommendations for radio-frequency ablation as a therapeutic option for Wolff-Parkinson-White syndrome in children as opposed to adults because of the different natural history and the age-related risks of ablation. To help decision-making, we evaluated the long term clinical evolution and electrophysiologic characteristics of pre-excitation in our series of children and young adults. We reviewed the clinical course of 109 patients below the age of 18 years who had been followed up over a period of 9+4 years, with a range from one to 27 years. This corresponded to 986 patient-years. We examined also the electrophysiologic data from 98 of those patients who underwent a transesophageal study. At the discovery of pre-excitation, 59% of patients were asymptomatic, while 29% developed supraventricular tachycardia during follow-up. The peak incidence of the onset of supraventricular tachycardia occurred during infancy. These patients had the highest incidence of subsequent spontaneous disappearance of the tachycardia (53%), such a favourable evolution being encountered in only 12% of patients in whom the abnormal rhythm first appeared after 12 years of age. Chronic medical treatment was required in 47% of patients, and proved completely effective in 45% of cases. The potential to induce atrial fibrillation, and the incidence pre-excitation considered to be high risk, with the shortest pre-excited RR interval equal to or less than 220 msec, was lowest in the group of patients aged less than 6 years of age, and highest in those older than 12 years of age (p <0.001). Pathways producing arrhythmia with high risk were more common in symptomatic (29%) than in asymptomatic patients (7%) (p<0.001). No mortality occurred. On the basis of our findings, we suggest that ablation should be avoided before the age of 5 or 6 years. Thereafter, the procedure should become the first line of treatment for symptomatic patients older than 12 years of age. |
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Authors:
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G Vignati; E Balla; L Mauri; M Lunati; A Figini |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Cardiology in the young Volume: 10 ISSN: 1047-9511 ISO Abbreviation: Cardiol Young Publication Date: 2000 Oct |
Date Detail:
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Created Date: 2000-11-29 Completed Date: 2000-12-22 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 9200019 Medline TA: Cardiol Young Country: ENGLAND |
Other Details:
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Languages: eng Pagination: 367-75 Citation Subset: IM |
Affiliation:
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Department of Cardiology De'Gasperis, Niguarda Hospital, Milan, Italy. famvi@iol.it |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Age Factors Catheter Ablation / adverse effects* Child Child, Preschool Decision Making Disease Progression Echocardiography, Transesophageal Female Follow-Up Studies Humans Incidence Infant Infant, Newborn Male Patient Selection* Risk Factors Tachycardia, Supraventricular / etiology* Treatment Outcome Wolff-Parkinson-White Syndrome / diagnosis*, therapy* |
| Comments/Corrections | |
Comment In:
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Cardiol Young. 2000 Oct;10(4):303-6
[PMID:
10950327
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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