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May 11, 2019Pacing and Clinical Electrophysiology

Can noninvasive testing identify benign patterns of suggested pre‐excitation on electrocardiogram?

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Key result

Classic accessory pathways exhibited significantly different ECG characteristics compared to benign pathways, including shorter PR-interval (102 vs 120 ms, P<0.0001) and longer QRS-duration.

Why the study?

Pre-excitation associated with classic accessory pathways can lead to sudden cardiac death, but it is difficult to differentiate from benign accessory pathways such as nodofascicular fibers.

Does noninvasive testing (ECG and exercise) differentiate classic from benign accessory pathways in patients with suggested pre-excitation?

Population

96 patients presenting with ventricular pre-excitation on ECG

Comparison

Classic accessory pathways vs benign or no accessory pathways

Design

Retrospective review

Authors

JRJeffrey A. RobinsonJAJeffrey AndersonTKTimothy K. Knilans

Discussion

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Overview

ECG differences may aid pathway classification; hypothesis-generating and requires prospective validation before clinical use.

Study Design

Type

Observational (n=96)

Structured PICO

Does noninvasive testing (ECG and exercise) differentiate classic from benign accessory pathways in patients with suggested pre-excitation?

P
Population
96 patients (mean age 14.2 years, 45% female) presenting with ventricular pre-excitation on ECG, evaluated to identify classic versus benign accessory pathways.
E
Exposure
Noninvasive testing (electrocardiogram and exercise testing)
C
Comparator
Comparison between classic and benign accessory pathways (as determined by invasive testing)
O
Outcome
ECG and exercise characteristics differentiating classic and benign accessory pathway connectionssurrogate

Main Result

Absolute Event Rate: 102% vs 120%

p-value: p=< .0001

Classic and benign accessory pathways exhibit different ECG characteristics, which may aid in risk stratification but do not replace the need for invasive testing.

Limitations

  • Clinical overlap does not allow for absolute differentiation
  • Does not obviate the need for additional invasive testing

Cite This Study

Robinson et al. (2019) conducted an observational in Ventricular pre-excitation on ECG (n=96). Classic accessory pathway vs. Benign accessory pathway was evaluated on PR-interval (ms) (p=< .0001). Classic accessory pathways exhibited significantly different ECG characteristics compared to benign pathways, including shorter PR-interval (102 vs 120 ms, P<0.0001) and longer QRS-duration.

synapsesocial.com/papers/6a71b38b8031ec7bb1dd13a4https://doi.org/10.1111/pace.13720
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Assessing and Managing Asymptomatic Ventricular Preexcitation in the Young Athlete2021
  2. 2Intermittent preexcitation indicates “a low‐risk” accessory pathway: Time for a paradigm shift?2017 · 20 citations
  3. 3The Electrophysiological Characteristics of Accessory Pathways in Pediatric Patients with Intermittent Preexcitation2013 · 44 citations
  4. 4Atypical Pre-excitation Pattern in Asymptomatic Wolff-Parkinson-White—A Hallmark for High Risk?2024
  5. 5Electrocardiographic Clues for Early Diagnosis of Ventricular Pre-Excitation and Non-Invasive Risk Stratification in Athletes: A Practical Guide for Sports Cardiologists2024 · 4 citations