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Catheter Ablation for Children with Asymptomatic WPW Syndrome?

Asymptomatic children with a Wolff-Parkinson-White ECG pattern benefited from catheter ablation, but there are important caveats.

Catheter ablation of accessory pathways (APs) can be accomplished in most centers with at least 95% efficacy and a 2% to 3% risk for major complications. Current guidelines recommend the procedure as first-line therapy for symptomatic Wolff-Parkinson-White (WPW) syndrome. A recent study suggested potential for benefit in adults with asymptomatic WPW syndrome, with some caveats (see Journal Watch Cardiology Jan 23 2004). What about in asymptomatic children?

Researchers in Italy enrolled 165 children (age range, 5-12 years) who had no symptomatic arrhythmias but showed a WPW pattern on ECG. All underwent diagnostic electrophysiologic (EP) testing; five (3%) experienced testing-related complications, and five (3%) experienced anesthesia-related complications.

Sixty children with inducible supraventricular arrhythmias were considered to be high risk and were randomized to catheter ablation or standard clinical follow-up. Several parents withdrew consent, leaving 20 children in the ablation group and 27 in the control group. APs were ablated successfully in all children in the ablation group. Three (15%) experienced non-life-threatening ablation-related complications.

During median follow-ups of 34 months in the ablation group and 19 months in the control group, arrhythmias occurred in 1 patient (5%) and 12 patients (44%), respectively. Two controls experienced ventricular fibrillation, and one died suddenly. In multivariable analysis, the absence of prophylactic catheter ablation and the presence of multiple APs were identified as independent predictors of arrhythmic events.

Comment: These results raise the possibility that asymptomatic children with a WPW ECG pattern would benefit from catheter ablation. However, all subjects were age 5 years or older; APs often resolve spontaneously in younger children. An editorialist cautions that less experienced centers might achieve less procedural success and notes that identifying eligible patients is difficult because WPW syndrome is rare (0.15% of the general population) and because screening ECGs are not routine in many countries. But if confronted with a child of age 5 to 12 years with asymptomatic WPW syndrome, clinicians should consider consulting an electrophysiologist to discuss the option of catheter ablation.

— Hugh Calkins, MD

Published in Journal Watch Cardiology November 12, 2004

Citation(s):

Pappone C et al. Radiofrequency ablation in children with asymptomatic Wolff-Parkinson-White syndrome. N Engl J Med 2004 Sep 16; 351:1197-205.

• Medline abstract (Free)

Wellens HJJ. Catheter ablation for cardiac arrhythmias. N Engl J Med 2004 Sep 16; 351:1172-4.

• Medline abstract (Free)

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