Epidemiology, clinical characteristics and life-threatening risk profile of WPW in children: 30 years population follow up at a single centre in South Wales

Abstract Backgrounds and Aims : This study aims to assess the epidemiology, clinical presentation, management, and outcomes of pediatric Wolff-Parkinson-White (WPW) syndrome, as well as the incidence of life-threatening events (LTE) in South Wales. Methods retrospective review of patients (< 17 years old) diagnosed with WPW syndrome between 1986 and 2019 in South Wales. Results The study population consisted of 160 patients, of whom 86 (54%) were male. The prevalence of WPW syndrome was 0.028%. Thirty percent of cases were diagnosed during infancy, while 63% presented after aged 5. Incidental diagnosis occurred in 47 (29,3%) asymptomatic patients. Spontaneous resolution of delta wave was observed in 19 patients (11.9%). Thirteen children (8.1%, 11 males) presented with an LTE, resulting in an estimated LTE risk of 3.8 per 1000 person-years during childhood in South Wales. Acute management was required in 36% (55/154) of patients, with seven experiencing preexcited atrial fibrillation (4.5%). Among children with preexcited atrial fibrillation and rapid ventricular conduction, only three out of seven children experienced aborted sudden cardiac death (1.9%). No deaths directly attributable to isolated WPW and related arrhythmia were recorded. Conclusions Asymptomatic WPW in children demonstrated a high propensity for life-threatening events in South Wales, prompting a policy shift towards earlier referral for electrophysiology study (EPS) prior to adolescence. These findings underscores the need for more rigorous risk stratification and closer follow-up of all WPW patients, as asymptomatic cases do not guarantee safety.