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The Electrophysiological Characteristics of Accessory Pathways in Pediatric Patients with Intermittent Preexcitation

Authors

  • DOUGLAS Y. MAH M.D.,

    Corresponding author
    1. Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
    2. the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
    • Address for reprints: Douglas Y. Mah, M.D., Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115. Fax: 617-739-9058; e-mail: Douglas.mah@cardio.chboston.org

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  • ELIZABETH D. SHERWIN M.D.,

    1. Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
    2. the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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  • MARK E. ALEXANDER M.D.,

    1. Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
    2. the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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  • FRANK CECCHIN M.D.,

    1. Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
    2. the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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  • DOMINIC J. ABRAMS M.D.,

    1. Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
    2. the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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  • EDWARD P. WALSH M.D.,

    1. Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
    2. the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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  • JOHN K. TRIEDMAN M.D.

    1. Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
    2. the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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  • Conflict of interest: There are no conflicts of interest or relevant financial or industry relationships to disclose.

Abstract

Background

Accessory pathways (APs) with intermittent preexcitation (IPX) are thought to be of lower risk, but there are reports of IPX patients presenting with rapidly conducted atrial fibrillation.

Methods

Retrospective study performed on patients with preexcitation who underwent an electro-physiological study (EPS). IPX was defined as loss of the delta wave on electrocardiogram prior to EPS. Patients with IPX were compared with those with persistent preexcitation (PPX) or suppression of the delta wave on exercise test (IPX-ET). Congenital heart disease and prior ablations were excluded.

Results

Of 328 patients with preexcitation, 41 (12.5%) had IPX. Patients with IPX or PPX were similar in age (12.9 years vs 13.0 years, P = 0.8) and AP location (left-sided 54% vs 50%, P = 0.7; septal 32% vs 35%, P = 0.4). Testing on isoproterenol was performed in 17 (41%) IPX and 41 (14%) PPX patients. Although IPX patients had a longer median refractory period compared to PPX patients (340 ms vs 310 ms, P = 0.001), the incidence of APs with refractory periods ≤250 ms was similar (10% vs 12%, P = 1.0). Exercise tests were performed on 208 patients and 24 (12%) had IPX-ET. Compared with IPX patients, IPX-ET had similar median AP refractory periods (320 ms, P = 0.4) and incidence of APs with refractory periods ≤250 ms (13%, P = 1.0).

Conclusion

Patients with IPX had longer AP refractory periods than those with PPX, but the incidence of pathways with refractory periods ≤250 ms was not significantly different. The finding of IPX on a baseline electrocardiogram does not rule out potentially high-risk pathways.

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