Radiofrequency Ablation in Children with Asymptomatic Wolff–Parkinson–White Syndrome

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.