Background Ventricular fibrillation can be the presenting arrhythmiain children with asymptomatic Wolff–Parkinson–Whitesyndrome. Deaths due to this arrhythmia are potentially preventable.
Methods We performed a randomized study in which prophylacticradiofrequency catheter ablation of accessory pathways was comparedwith no ablation in asymptomatic children (age range, 5 to 12years) with the Wolff–Parkinson–White syndrome whowere at high risk for arrhythmias. The primary end point wasthe occurrence of arrhythmic events during follow-up.
Results Of the 165 eligible children, 60 were determined tobe at high risk for arrhythmias. After randomization, but beforeany ablation had been performed, the parents withdrew 13 childrenfrom the study. Of the remaining children, 20 underwent prophylacticablation and 27 had no treatment. The characteristics of thetwo groups were similar. There were three ablation-related complications,one of which led to hospitalization. During follow-up, 1 childin the ablation group (5 percent) and 12 in the control group(44 percent) had arrhythmic events. Two children in the controlgroup had ventricular fibrillation, and one died suddenly. Thecumulative rate of arrhythmic events was lower among childrenat high risk who underwent ablation than among those at highrisk who did not. The reduction in risk associated with ablationremained significant after adjustment in a Cox regression analysis.In both the ablation and the control groups, the independentpredictors of arrhythmic events were the absence of prophylacticablation and the presence of multiple accessory pathways.
Conclusions In asymptomatic, high-risk children with the Wolff–Parkinson–Whitesyndrome, prophylactic catheter ablation performed by an experiencedoperator reduces the risk of life-threatening arrhythmias.
Source Information
From the Department of Cardiology, Electrophysiology and Cardiac Pacing Unit, San Raffaele University Hospital, Milan (C.P., F.M., G.V., S.S., G.P., P.M., C.C.L., S.G., G.A., O.S., V.S.); and the Department of Pediatrics, University of Naples, Naples (R.S.) — both in Italy.
Address reprint requests to Dr. Pappone at the Department of Cardiology, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy, or at carlo.pappone{at}hsr.it.
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