Follow-up of 134 Pediatric Patients with Wolff-Parkinson-White Pattern: Natural Outcome and Medical Treatment

ObjectiveThe aim of the study was to evaluate the outcome of a pediatric population withventricular pre-excitation pattern, supraventricular tachycardia, atrial fibrillation,cardiomyopathies, mortality and medical treatment.MethodsFrom 1976 to 2011, a descriptive observational study was conducted on patientswith ventricular pre-excitation in the electrocardiogram. All patients underwent anechocardiogram, 101(75.3%) Holter monitoring, and 69 (51.5%) an ergometric test.Radiofrequency ablation was performed in selected patients. Data were expressed asmean and standard deviation.ResultsThe study population consisted of 134 patients; 80 (59.7%) were male. Age at diagnosisranged from 2 days to 18 years (mean 6.5±5 years). Clinical follow-up lasted1 month to 20 years (mean 3.6±3.9 years). Thirty five patients (26.1%) consultedfor supraventricular tachycardia, 16 (11.9%) for ventricular pre-excitation, and theremaining 83 patients (61.9%) for other abnormalities. Seventy-six patients (56.7%)had left conduction pathway and 3 patients double conduction pathway. Sixteen patients(11.9%) presented supraventricular tachycardia during follow-up. Overall, 51patients (38%) had orthodromic tachycardia at 6.3±5.8 years, 10 patients duringthe neonatal period. Thirty-eight patients (28.3%) received antiarrhythmic drugs.No atrial fibrillation was observed. Twenty-eight patients (20.9%) presented cardiomyopathy,9 with supraventricular tachycardia. No association was found betweensupraventricular tachycardia and another variable. Forty-three patients (32.1%)underwent radiofrequency ablation. A patient suffered sudden death and anotherpatient died during the postoperative period of cardiomyopathy surgery.Conclusions1. More than 60% of patients remained asymptomatic. 2) No atrial fibrillation wasrecorded. 3) Sudden death rate was 0.75%. 4) Patients with supraventricular tachycardianot submitted to ablation had a favorable outcome. 5) Supraventricular tachycardiawas not associated with any variable. 6) Multiple conduction pathways alwaysdeveloped supraventricular tachycardia.