Safe cochlear implantation in a child with Wolff-Parkinson-White syndrome

Wolff-Parkinson-White (WPW) syndrome is a congenital cardiac conduction abnormality. It is characterised by ventricular pre-excitation that arises from abnormal electrical conduction through an accessory pathway which bypasses the normal cardiac conduction. It is often asymptomatic in children but carries a risk of life-threatening arrhythmias, particularly during physiological stress. We report the perioperative strategies adopted in the management of a cochlear implantation in a toddler who was incidentally noted to have asymptomatic WPW syndrome during preoperative assessment. The child was evaluated for speech delay and diagnosed with bilateral congenital profound sensorineural hearing loss. A routine ECG revealed WPW pattern. Subsequent cardiology evaluation reported no evidence of any structural heart disease and it was decided to proceed with cochlear implantation without cardiac ablation. In anticipation of potential arrhythmias, several anaesthetic and surgical measures were taken to ensure safe and successful surgery. This case highlights the importance of routine preoperative ECG screening, multidisciplinary planning and follow-up to ensure safe cochlear implantation in children with occult arrhythmogenic conditions.