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Sports Eligibility After Risk Assessment and Treatment in Children with Asymptomatic Ventricular Pre-excitation

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Abstract

Background and Objective

Many studies concern the management of young patients with symptomatic Wolff-Parkinson-White (WPW) syndrome, but little information exists on the significance and prognosis of ventricular pre-excitation (VPE) in asymptomatic children. The aim of the study was to evaluate the risk of sudden death in young athletes with asymptomatic VPE by transesophageal electrophysiological study (TEEPS) and their sports eligibility after the risk assessment and/or ablative treatment.

Methods

Ninety-one asymptomatic children and adolescents underwent TEEPS both at rest and during adrenergic stress (exercise testing or isoproterenol infusion). After electrophysiological testing, patients were assessed in the 36 months of follow-up.

Results

Thirty-three patients (36.3 %) had a benign form of VPE and were allowed to participate in competitions. Ten patients (11 %) were at borderline risk; thus, sport eligibility was evaluated individually. Forty-eight patients (52.7 %) showed inducible sustained atrioventricular reentrant tachycardia and/or atrial fibrillation (AF), 11 of whom (12.1 % of total population) had a potential risk of sudden cardiac death due to AF inducibility during physical stress. Forty-five young athletes underwent transcatheter ablation (TCA). TCA was interrupted in 12 patients (26.7 %) because of the high procedural risk linked to septal accessory pathway (AP) location. There were no TCA-related complications, and all patients remained asymptomatic during follow-up.

Conclusion

Most of the young athletes with asymptomatic VPE may be allowed to participate in competitive sports after an adequate risk assessment and/or ablative treatment. However, in our opinion, special care should be taken to avoid procedural complications, which are unacceptable in asymptomatic patients.

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Notes

  1. Rarely, in some patients with AP septal locations, ventricular dysfunction can be observed, even with a lack of symptoms. In these patients, competitive sports activity is not suggested and a TCA is indicated.

References

  1. Corrado D, Basso C, Rizzoli G, et al. Does sports activity enhance the risk of sudden death in adolescents and young adults? J Am Coll Cardiol. 2003;42:1959–63.

    Article  PubMed  Google Scholar 

  2. Bricker JT, Porter CJ, Garson A Jr, et al. Exercise testing in children with Wolff-Parkinson-White syndrome. Am J Cardiol. 1985;55:1001–4.

    Article  CAS  PubMed  Google Scholar 

  3. Cohen MI, Triedman JK, Cannon BC, et al. PACES/HRS expert consensus statement on the management of the asymptomatic young patient with a Wolff-Parkinson-White (WPW, ventricular preexcitation) electrocardiographic pattern: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Heart Rhythm. 2012;9:1006–24.

    Article  PubMed  Google Scholar 

  4. Italian Cardiological Committee on Sports Eligibility (COCIS). Cardiovascular guidelines for competitive sports eligibility 2009. Rome: CESI; 2012.

  5. Corrado D, Pelliccia A, Bjørnstad HH, et al. Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J. 2005;26:516–24.

    Article  PubMed  Google Scholar 

  6. Boersma L, Garcia-Moran E, Mont L, et al. Accessory pathway localization by QRS polarity in children with Wolff-Parkinson-White syndrome. J Cardiovasc Electrophysiol. 2002;13:1222–6.

    Article  PubMed  Google Scholar 

  7. Drago F, Turchetta A, Calzolari A, et al. Detection of atrial vulnerability by transesophageal atrial pacing and the relation of symptoms in children with Wolff-Parkinson-White syndrome and in a symptomatic control group. Am J Cardiol. 1994;74:400–1.

    Article  CAS  PubMed  Google Scholar 

  8. Hessling G, Brockmeier K, Ulmer HE. Transesophageal electrocardiography and atrial pacing in children. J Electrocardiol. 2002;35:143–9.

    Article  PubMed  Google Scholar 

  9. Wellens HJ, Brugada P, Roy D, et al. Effect of isoproterenol on the anterograde refractory period of the accessory pathway in patients with the Wolff-Parkinson-White syndrome. Am J Cardiol. 1982;50:180–4.

    Article  CAS  PubMed  Google Scholar 

  10. Li HG, Yee R, Klein GJ. Effect of isoproterenol on accessory pathways without overt retrograde conduction. J Cardiovasc Electrophysiol. 1995;6:170–3.

    Article  CAS  PubMed  Google Scholar 

  11. Drago F, Turchetta A, Calzolari A, et al. Reciprocating supraventricular tachycardia in children: low rate at rest as a major factor related to propensity to syncope during exercise. Am Heart. 1996;132:280–5.

    Article  CAS  Google Scholar 

  12. Guize L, Soria R, Chaouat JC, et al. Prevalence and course of Wolff-Parkinson-White syndrome in a population of 138,048 subjects. Ann Med Interne (Paris). 1985;136:474–8.

    CAS  Google Scholar 

  13. Hiss RG, Lamb LE. Electrocardiographic findings in 122,043 individuals. Circulation. 1962;25:947–61.

    Article  CAS  PubMed  Google Scholar 

  14. Rodday AM, Triedman JK, Alexander ME, et al. Electrocardiogram screening for disorders that cause sudden cardiac death in asymptomatic children: a meta-analysis. Pediatrics. 2012;129:e999. doi:10.1542/peds.2011-0643 (published Online First: 05 Mar 2012).

    Article  PubMed  PubMed Central  Google Scholar 

  15. Furlanello F, Bertoldi A, Dallago M, et al. Atrial fibrillation in elite athletes. J Cardiovasc Electrophysiol. 1998;9:S63–8.

    CAS  PubMed  Google Scholar 

  16. Deal BJ, Keane JF, Gillette PC, et al. Wolff-Parkinson-White syndrome and supraventricular tachycardia during infancy: management and follow-up. J Am Coll Cardiol. 1985;5:130–5.

    Article  CAS  PubMed  Google Scholar 

  17. Munger TM, Packer DL, Hammill SC, et al. A population study of the natural history of Wolff-Parkinson-White syndrome in Olmsted County, Minnesota, 1953–1989. Circulation. 1993;87:866–73.

    Article  CAS  PubMed  Google Scholar 

  18. Maron BJ, Doerer JJ, Haas TS, et al. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980–2006. Circulation. 2009;119:1085–92.

    Article  PubMed  Google Scholar 

  19. Klein GJ, Bashore TM, Sellers TD, et al. Ventricular fibrillation in the Wolff-Parkinson-White syndrome. N Engl J Med. 1979;301:1080–5.

    Article  CAS  PubMed  Google Scholar 

  20. Klein GJ, Prystowsky EN, Yee R, et al. Asymptomatic Wolff-Parkinson-White. Should we intervene? Circulation. 1989;80:1902–5.

    Article  CAS  PubMed  Google Scholar 

  21. Timmermans C, Smeets JL, Rodriguez LM, et al. Aborted sudden death in the Wolff-Parkinson-White syndrome. Am J Cardiol. 1995;76:492–4.

    Article  CAS  PubMed  Google Scholar 

  22. Obeyesekere MN, Leong-Sit P, Massel D, et al. Risk of arrhythmia and sudden death in patients with asymptomatic preexcitation: a meta-analysis. Circulation. 2012;125:2308–15.

    Article  PubMed  Google Scholar 

  23. Daubert C, Ollitrault J, Descaves C, et al. Failure of the exercise test to predict the anterograde refractory period of the accessory pathway in Wolff-Parkinsons-White syndrome. Pacing Clin Electrophysiol. 1988;11:1130–8.

    Article  CAS  PubMed  Google Scholar 

  24. Santinelli V, Radinovic A, Manguso F, et al. The natural history of asymptomatic ventricular pre-excitation: a long-term prospective follow-up study of 184 asymptomatic children. J Am Coll Cardiol. 2009;53:275–80.

    Article  PubMed  Google Scholar 

  25. Pappone C, Santinelli V, Rosanio S, et al. 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. J Am Coll Cardiol. 2003;41:239–44.

    Article  PubMed  Google Scholar 

  26. Pappone C, Vicedomini G, Manguso F, et al. Wolff-Parkinson-White syndrome in the era of catheter ablation: insights from a registry study of 2169 patients. Circulation. 2014;130:811–9.

    Article  PubMed  Google Scholar 

  27. Di Mambro C, Russo MS, Righi D, et al. Ventricular pre-excitation: symptomatic and asymptomatic children have the same potential risk of sudden cardiac death. Europace. 2015;17:617–21.

    Article  PubMed  Google Scholar 

  28. Lee PC, Hwang B, Tai CT, et al. The different electrophysiological characteristics in children with Wolff-Parkinson-White syndrome between those with and without atrial fibrillation. Pacing Clin Electrophysiol. 2004;27:235–9.

    Article  PubMed  Google Scholar 

  29. Sarubbi B, D’Alto M, Vergara P, et al. Electrophysiological evaluation of asymptomatic ventricular pre-excitation in children and adolescents. Int J Cardiol. 2005;98:207–14.

    Article  PubMed  Google Scholar 

  30. Kubuš P, Vít P, Gebauer RA, et al. Electrophysiologic profile and results of invasive risk stratification in asymptomatic children and adolescents with the Wolff-Parkinson-White electrocardiographic pattern. Circ Arrhythm Electrophysiol. 2014;7:218–23.

    Article  PubMed  Google Scholar 

  31. Spar DS, Silver ES, Hordof AJ, et al. Relation of the utility of exercise testing for risk assessment in pediatric patients with ventricular preexcitation to pathway location. Am J Cardiol. 2012;7:1011–4.

    Article  Google Scholar 

  32. De Ponti R, Marazzi R, Doni LA, et al. Invasive electrophysiological evaluation and ablation in patients with asymptomatic ventricular pre-excitation persistent at exercise stress test. Europace. 2015;17:946–52.

    Article  PubMed  Google Scholar 

  33. Brembilla-Perrot B, Chometon F, Groben L, et al. Interest of non-invasive and semi-invasive testings in asymptomatic children with pre-excitation syndrome. Europace. 2007;9:837–43.

    Article  CAS  PubMed  Google Scholar 

  34. Van Hare GF, Javitz H, Carmelli D, et al. Pediatric Electrophysiology Society. Prospective assessment after pediatric cardiac ablation: demographics, medical profiles, and initial outcomes. J Cardiovasc Electrophysiol. 2004;15:759–70.

    Article  PubMed  Google Scholar 

  35. Drago F, Silvetti MS, De Santis A, et al. Lenghtier cryoablation and a bonus cryoapplication is associated with improved efficacy for cryothermal catheter ablation of supraventricular tachycardias in children. J Interv Card Electrophysiol. 2006;16:191–8.

    Article  PubMed  Google Scholar 

  36. Drago F, Righi D, Placidi S, et al. Cryoablation of right-sided accessory pathways in children: report of efficacy and safety after 10-year experience and follow-up. Europace. 2013;15:1651–6.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank Dr. Elisa Del Vecchio for her valuable collaboration in the editorial revision and Dr. Elena Wolodimeroff for technical assistance.

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Authors and Affiliations

  1. Complex Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Via Torre di Palidoro, 00050, Fiumicino, Rome, Italy

    Corrado Di Mambro, F. Drago, M. Milioni, M. S. Russo, D. Righi, S. Placidi, R. Remoli, R. Palmieri, F. Gimigliano, L. M. Santucci, M. S. Silvetti & M. Prosperi

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  1. Corrado Di Mambro
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  2. F. Drago
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  3. M. Milioni
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  4. M. S. Russo
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  5. D. Righi
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  6. S. Placidi
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  7. R. Remoli
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  9. F. Gimigliano
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  10. L. M. Santucci
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  11. M. S. Silvetti
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  12. M. Prosperi
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Correspondence to Corrado Di Mambro.

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Conflict of interest

Authors Di Mambro C, Drago F, Milioni M, Russo MS, Righi D, Placidi S, Remoli R, Palmieri R, Gimigliano F, Santucci LM, Silvetti MS and Prosperi M declare that they have no conflict of interest.

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No financial support was received for the conduct of this study or preparation of this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration its later amendments or comparable ethical standards.

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Di Mambro, C., Drago, F., Milioni, M. et al. Sports Eligibility After Risk Assessment and Treatment in Children with Asymptomatic Ventricular Pre-excitation. Sports Med 46, 1183–1190 (2016). https://doi.org/10.1007/s40279-016-0475-3

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