What does this research mean for the field?

Asymptomatic children under 12 years of age with Wolff-Parkinson-White syndrome exhibit a lower incidence of inducible atrial fibrillation and generally have lower-risk accessory pathways compared to older children. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

March 3, 2026Open Access

Transesophageal Electrophysiological Study in Children Under 12 Years of Age with Asymptomatic Wolff–Parkinson–White Syndrome

Key Points

Children under 12 years showed a lower incidence of inducible atrial fibrillation, indicating a reduced risk profile.
The mean effective refractory period of accessory pathways was similar in both age groups, suggesting consistency in electrophysiological properties.

Structured PICO

Does the electrophysiological risk profile differ between asymptomatic WPW children under 12 years and over 12 years of age when assessed via transesophageal study?

Population

41 asymptomatic children with Wolff-Parkinson-White (WPW) syndrome, mean age 12.5 ± 4.4 years (range 1 to 18 years), 48.8% male.

Intervention

Transesophageal electrophysiological study (with sedation for children under 12 years of age)

Comparator

Children over 12 years of age (without sedation)

Outcome

Electrophysiological risk parameters including accessory pathway effective refractory period (APERP), minimal cycle length demonstrating 1:1 conduction through the accessory pathway, and shortest RR interval between two consecutive pre-excited beats during atrial fibrillationsurrogate

Transesophageal electrophysiological studies in asymptomatic children with WPW syndrome demonstrate that children under 12 years generally exhibit low-risk accessory pathway properties and a lower incidence of inducible atrial fibrillation.

Abstract

Background/Objectives: Patients with WPW syndrome have a risk of sudden cardiac death that can be assessed using an electrophysiological study. In symptomatic patients, the preferred route is intracardiac, whereas in asymptomatic children, transesophageal. Our study aimed to evaluate the risk using a transesophageal study, considering a threshold age of 12 years for sedation. Methods: We investigated 41 asymptomatic WPW children with a mean age of 12.5 ± 4.4 years (range 1 to 18 years old), with 48.8% being male. We determined three values: (1) the accessory pathway effective refractory period (APERP), (2) the minimal cycle length demonstrating 1:1 conduction through the accessory pathway, and (3) the shortest RR interval between two consecutive pre-excited beats during atrial fibrillation. Results: Children under 12 years had a mean age of 7.5 ± 2.5 years, while those over 12 years had a mean age of 15.5 ± 1.9 years. Sedation was administered exclusively to children under 12 years of age. Orthodromic reentrant tachycardia was induced in four children, and atrial fibrillation was induced in 14 children. Comparing the group under 12 with the group over 12, the mean APERP was 296 ± 38 ms vs. 286 ± 45 ms (p = 0.48), the average 1:1 conduction over the accessory pathway was 287.3 ± 41 ms vs. 282 ± 46 ms (p = 0.71), and the average shortest pre-excited RR interval during atrial fibrillation was 280 ms vs. 262 ms years (p = 0.75). Conclusions: Asymptomatic children under 12 years of age showed a lower incidence of inducible atrial fibrillation. They had accessory pathways with reduced risk, except one, and no children under 12 years underwent catheter ablation.

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