Rodriguez-Gonzalez Moises, Castellano-Martinez Ana, Perez-Reviriego Alvaro A
Department of Pediatric Cardiology, Puerta del Mar University Hospital, Cadiz, Spain.
Biomedical Research and Innovation Institute of Cadiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cadiz, Cadiz, Spain.
Curr Cardiol Rev. 2020;16(2):83-89. doi: 10.2174/1573403X15666190301150754.
Asymptomatic VPE refers to the presence of this abnormal ECG pattern in the absence of any symptoms. The natural history in these patients is usually benign, and most children (60%) with VPE are usually asymptomatic. However, Sudden Cardiac Death (SCD) has been reported to be the initial symptom in many patients too. The increased risk of SCD is thought to be due to the rapid conduction of atrial arrhythmias to the ventricle, via the AP, which degenerates into Ventricular Fibrillation (VF). The best method to identify high-risk patients with asymptomatic VPE for SCD is the characterization of the electrophysiological properties of the AP through an Electrophysiological Study (EPS). Also, catheter ablation of the AP with radiofrequency as definitive treatment to avoid SCD can be performed by the same procedure with high rates of success. However, the uncertainty over the absolute risk of SCD, the poor positive predictive value of an invasive EPS, and complications associated with catheter ablation have made the management of asymptomatic VPE challenging, even more in those children younger than 8-year-old, where there are no clear recommendations. This review provides an overview of the different methods to make the risk stratification for SCD in asymptomatic children with, as well as our viewpoint on the adequate approach to those young children not included in current guidelines.
无症状性预激综合征（VPE）是指在无任何症状的情况下出现这种异常心电图模式。这些患者的自然病程通常是良性的，大多数患有VPE的儿童（60%）通常无症状。然而，也有报道称，许多患者最初的症状是心源性猝死（SCD）。SCD风险增加被认为是由于房性心律失常通过旁路快速传导至心室，进而恶化为心室颤动（VF）。识别无症状性VPE的SCD高危患者的最佳方法是通过电生理研究（EPS）来表征旁路的电生理特性。此外，通过相同的高成功率程序，可以采用射频导管消融旁路作为避免SCD的确定性治疗方法。然而，SCD绝对风险的不确定性、侵入性EPS的阳性预测值低以及与导管消融相关的并发症，使得无症状性VPE的管理具有挑战性，对于8岁以下儿童更是如此，因为目前尚无明确的建议。本综述概述了对无症状儿童SCD进行风险分层的不同方法，以及我们对当前指南未涵盖的年幼儿童适当处理方法的观点。
