预激综合征Pre-excitation Syndromes.ppt

How do we decide which Asymptomatics to treat ? Risk Stratification Invasive Non-invasive Traditionally accepted risk factors for SCD with WPW syndrome in adults: H/O symptomatic tachycardia Shortest pre-excited RR interval 250 ms during spontaneous or induced AF Rapid ventricular response over an AP during AF (spontaneous or induced during EPS) Multiple accessory pathways Ebsteins anomaly Familial WPW These criteria have been derived mainly from studies involving adult patients – extensively described Not enough comparable studies in children In adults, clinical history plays an important role in planning the management of WPW However, multiple studies (Deal et al, Blomberg et al, Dubin et al) have shown that a large proportion of children with WPW who suffered SCD had NO previous arrhythmias / symptoms Deal et al : nearly 50%, Blomberg et al : 9/10 (90%) Dubin et al showed that the commonly accepted invasive criteria in adults don’t differentiate symptomatic from asymptomatic children with WPW ERPs of APs may be an invalid criterion when applied to children Timmerman et al associated ‘septal pathways’ to increased risk of SCD in adults – not validated in children Russel et al and Blomberg et al reported left-sided pathways to be associated with increased risk of SCD in children Dubin et al reported that there was no relationship between location or number of pathways, ERPs of pathways, history of syncope, SCD or SVT Reproducibly inducible tachycardia over the Accessory Pathway on EP Study has been reported to be, perhaps, the most important factor predicting the risk of SCD in asymptomatic children with pre-excitation Dubin et al reported that 61% of asymptomatic patients with WPW had inducible AVRT and 2/23 had ART ; 2/23 had ERPs 240ms Maybe this group of “asymptomatic” children includes a large number who are destined to develop symptoms by adulthood Sarubbi et al reported inducible SVT in 49% of asymptomatic patients with pre-excitation who underwe