Key result
Ventricular pre-excitation risk profiles change in ~14% of pediatric athletes, driven by decreased pathway refractoriness.
Why the study?
Risk stratification is recommended for ventricular pre-excitation especially for sports eligibility, but few studies have evaluated changes in accessory pathway electrophysiological properties during growth.
How do the electrophysiological properties of ventricular pre-excitation change over time during growth in paediatric athletes?
Cohort (n=44)
How do the electrophysiological properties of ventricular pre-excitation change over time during growth in paediatric athletes?
Electrophysiological properties of accessory pathways in pediatric athletes can change significantly during growth, warranting repeat testing for risk stratification.
Serial risk reassessment may be considered during growth in paediatric athletes with pre-excitation; hypothesis-generating for dynamic stratification, prospective trials needed.
AIM: Risk stratification is recommended for patients with ventricular pre-excitation, particularly when sports eligibility is required. Few studies have examined the changes in the electrophysiological properties of the accessory pathway during growth. This study investigates the evolution of electrophysiological properties of the ventricular pre-excitation in young athletes referred for sports eligibility. METHODS: Between January 2011 and July 2022, 44 paediatric patients (32 males; mean age, 10 ± 2.42) with ventricular pre-excitation underwent an electrophysiological study, both at rest and during adrenergic stress at two different times (T0 and T1) within a minimal interval of 2 years. Transcatheter ablation was not performed between the two electrophysiological studies. Electrophysiological data were collected and compared. RESULTS: Electrophysiological study under basal conditions showed a significant decrease in the anterograde accessory pathway effective refractory period and 1:1 conduction over the accessory pathway from T0 to T1. The shortest pre-excited R-R interval during atrial fibrillation did not significantly change at the basal condition; however, it decreased during the stress test. Furthermore, six patients (13.6%) changed the risk profile of their accessory pathway: two "high-risk" patients at T0 became "low-risk" and four "low-risk" patients became "high-risk" at T1. Atrioventricular re-entry tachycardia inducibility did not differ significantly between the two electrophysiological studies. CONCLUSIONS: This study highlights the importance of repeating electrophysiological study (transesophageal or intracardiac) in paediatric athletes with ventricular pre-excitation because significant and clinically relevant changes in the conduction and refractoriness of accessory pathway can occur. This could influence risk stratification for sports eligibility and the correct indication and timing for accessory pathway ablation.
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Raimondo et al. (2024) conducted a cohort in Ventricular pre-excitation (n=44). Growth (time interval of ≥2 years) vs. Baseline (T0) was evaluated on Change in electrophysiological properties of the accessory pathway and risk profile. Over a minimum 2-year follow-up, 13.6% of paediatric athletes with ventricular pre-excitation changed their risk profile, with significant decreases in accessory pathway refractoriness.
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