The Use of Trans-Esophageal Electrophysiology Study to Identify a High Risk Asymptomatic Wolff Parkinson White Syndrome Patient

Manoj Gupta, Walter Hoyt, Christopher S. Snyder

Division of Pediatric Cardiology, Department of Pediatrics, Rainbow Babies and Children’s Hospital, Cleveland, OH, USA.
Division of Pediatric Cardiology, Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, VA, USA.

DOI: 10.4236/ojped.2014.43030                

Abstract

Patients with a Wolff-Parkinson-White (WPW) pattern on their ECG can experience symptoms such as syncope, palpitations, supraventricular tachycardia, and atrial fibrillation, or they can be asymptomatic (aWPW). All patients with WPW, regardless of the presence or absence of symptoms, are at risk of sudden death. Therefore, it is recommended that younger patients with WPW undergo studies to determine their risk. We report a previously asymptomatic WPW patient identified as high risk for sudden death due to rapid conduction down her accessory pathway during atrial fibrillation induced during a trans-esophageal electrophysiology study.

Keywords

Wolff-Parkinson-White Syndrome, Risk Assessment

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Munger, T.M., Packer, D.L., Hammil, S.C., Feldman, B.J., Bailey, K.R., Ballard, D.J., Holmes Jr., D.R. and Gersh, B.J. (1993) A Population Study of the Natural History of Wolff-Parkinson-White Syndrome in Olmsted County, Minnesota, 1953-1989. Circulation, 87, 866-873 http://dx.doi.org/10.1161/01.CIR.87.3.866
[2]	Perry, J. (1998) Supraventricular Tachycardia. In: Garson Jr., A., Bricker, J.T., Fisher, D.J. and Neish, S.R., Eds., Science and Practice of Pediatric Cardiology, Williams & Wilkins, Baltimore, 2059-2101.
[3]	Wellens, H.J., Rodriguez, L.M., Timmermans, C. and Smeets, J.L. (1997) The Asymptomatic Patient with Wolff-Parkinson-White Electrocardiogram. PACE, 20, 2082-2086. http://dx.doi.org/10.1111/j.1540-8159.1997.tb03633.x
[4]	Goudevenos, J.A., Katsouras, C.S., Graekas, G., et al. (2000) Ventricular Preexcitation in the General Population: A Study on the Mode of Presentation and Clinical Course. Heart, 83, 29-34. http://dx.doi.org/10.1136/heart.83.1.29
[5]	Pietersen, A.H., Andersen, E.D. and Sandoe, E. (1992) Atrial Fibrillation in the Wolff-Parkinson-White Syndrome. The American Journal of Cardiology, 70, 38A-43A. http://dx.doi.org/10.1016/0002-9149(92)91076-G
[6]	Klein, G.J., Bashore, T.M., Sellers, T.D., Pritchett, E.L., Smith, W.M. and Gallagher, J.J. (1979) Ventricular Fibrillation in the Wolff-Parkinson-White Syndrome. The New England Journal of Medicine, 301, 1080-1085. http://dx.doi.org/10.1056/NEJM197911153012003
[7]	Bromberg, B.I., Lindsay, B., Cain, M. and Cox, J. (1996) Impact of Clinical History and Electrophysiologic Characterization of Accessory Pathways on Management Strategies to Reduce Sudden Death among Children With Wolff-Parkinson-White Syndrome. Journal of the American College of Cardiology, 27, 690-695. http://dx.doi.org/10.1016/0735-1097(95)00519-6
[8]	PACES/HRS(2012) Expert Consensus Statement on the Management of the Asymptomatic Young Patient with a Wolff-Parkinson-White (WPW, Ventricular Preexcitation) Electrocardiographic Pattern. Heart Rhythm, 9, 1006-1024 http://dx.doi.org/10.1016/j.hrthm.2012.03.050
[9]	Gaita, F., Giusteto, C., Riccardi, R., Mangiardi, L. and Brusca, A. (1989) Stress and Pharmacologic Tests as Methods to Identify Patients with Wolff-Parkinson-White Syndrome at Risk of Sudden Death. The American Journal of Cardiology, 64, 487-490. http://dx.doi.org/10.1016/0002-9149(89)90426-8
[10]	Sharma, A., Yee, R., Guiraudon, G. and Klein, G. (1987) Sensitivity and Specificity of Invasive and Non-invasive Testing for Risk of Sudden Death in Wolff-Parkinson-White Syndrome. Journal of the American College of Cardiology, 10, 373-381 http://dx.doi.org/10.1016/S0735-1097(87)80021-9
[11]	Santinelli, V., et al. (2009) The Natural History of Asymptomatic Ventricular Pre-Excitation: A Long-Term Prospective Follow-Up Study of 184 Asymptomatic Children. Journal of the American College of Cardiology, 53, 275-280. http://dx.doi.org/10.1016/j.jacc.2008.09.037
[12]	Pappone, C., Santinelli, V., Rosanio, S., Vicedomini, G., Nardi, S., Pappone, A., Tortoriello, V., Manguso, F., Mazzone, P., Gulletta, S., Oreto, G. and Alfieri O. (2003) Usefulness of Invasive Electrophysiologic Testing to Stratify the Risk of Arrhythmic Events in Asymptomatic Patients with Wolff-Parkinson-White Pattern: Results from a Large Prospective Long-Term Follow-Up Study. Journal of the American College of Cardiology, 41, 239-244. http://dx.doi.org/10.1016/S0735-1097(02)02706-7
[13]	Bricker, J.T., Co-Burn, J., Garson Jr., A., Gillete, P.C., McVey, P., Malinda, T. and McNamara, D. (1984) Exercise Testing in Children with Wolff-Parkinson-White Syndrome. The American Journal of Cardiology, 55, 1001-1004. http://dx.doi.org/10.1016/0002-9149(85)90734-9
[14]	Moltedo, J.M., Iyer, R.V., Forman, H., Fahey, J., Rosenthal, G. and Snyder, C.S. (2006) Is Exercise Stress Testing a Cost-Saving Strategy for Risk Assessment of Pediatric Wolff-Parkinson-White Syndrome Patients? The Ochsner Journal, 6, 64-67.