Paech C, Wagner F, Strehlow V, Gebauer R A
Department for Pediatric Cardiology, University of Leipzig - Heart Center, Strümpellstr. 39, 04289, Leipzig, Germany.
Department for Human Genetics, University of Leipzig, Philipp-Rosenthal Str. 55, 04103, Leipzig, Germany.
Pediatr Cardiol. 2019 Jan;40(1):194-197. doi: 10.1007/s00246-018-1979-4. Epub 2018 Sep 10.
Ablation of accessory pathways (AP) is one of the most often performed procedures in pediatric electrophysiology. In pediatric patients these procedures are mostly performed in anaesthesia or sedation. In some of these patients who are referred for electrophysiologic (EP) study, we could observe disappearance of the preexcitation, i.e. antegrade conduction of an AP during introduction of sedation. As a suppression of AP conduction capacities has been reported as negative side effect of propofol and other anaesthetics, the aim of this study was to evaluate risk factors for drug-induced suppression of AP conduction properties. Consecutive, pediatric patients with Wolff-Parkinson-White (WPW) pattern referred for EP study in the period of 2016-2017 were reviewed in retrospect. Patients with complex congenital heart disease were excluded. An entire chart review including ECG, bicycle stress testing, and periprocedural data was performed. In 4 of 37 patients included into the study, loss of preexcitation could be observed during sedation. Data analysis showed weaker conduction capacities of the AP as a risk factor (p = 0.009). Interestingly, absolute (p = 0.11) or adjusted to body weight (p = 0.92) drug doses were not a relevant risk factor. Patients with WPW and weaker conduction capacities of the AP, as implied by an early disappearance of preexcitation during exercise stress testing, seem to be more prone to drug-induced suppression of an AP.
消融旁路（AP）是儿科电生理学中最常进行的手术之一。在儿科患者中，这些手术大多在麻醉或镇静状态下进行。在一些因电生理（EP）检查而转诊的患者中，我们观察到在引入镇静剂期间预激消失，即AP的前向传导消失。由于丙泊酚和其他麻醉剂的副作用之一是抑制AP传导能力，本研究的目的是评估药物诱导的AP传导特性抑制的危险因素。回顾性分析了2016 - 2017年期间因EP检查而转诊的连续的患有 Wolff-Parkinson-White（WPW）综合征的儿科患者。排除患有复杂先天性心脏病的患者。对包括心电图、自行车运动试验和围手术期数据在内的整个病历进行了审查。在纳入研究的37例患者中，有4例在镇静期间观察到预激消失。数据分析显示AP传导能力较弱是一个危险因素（p = 0.009）。有趣的是，绝对药物剂量（p = 0.11）或根据体重调整后的药物剂量（p = 0.92）并不是相关危险因素。WPW综合征且AP传导能力较弱的患者，如运动应激试验期间预激早期消失所暗示的，似乎更容易受到药物诱导的AP抑制。
