在非侵入性检查期间丧失心室预激并不排除高风险的附加旁路：儿童 WPW 的多中心研究。
Loss of ventricular preexcitation during noninvasive testing does not exclude high-risk accessory pathways: A multicenter study of WPW in children.
机构信息
Department of Pediatrics, Division of Pediatric Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada.
Division of Pediatric Cardiology, Department of Cardiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California.
出版信息
Heart Rhythm. 2020 Oct;17(10):1729-1737. doi: 10.1016/j.hrthm.2020.05.035. Epub 2020 Jun 1.
BACKGROUND
Abrupt loss of ventricular preexcitation on noninvasive evaluation, or nonpersistent preexcitation, in Wolff-Parkinson-White syndrome (WPW) is thought to indicate a low risk of life-threatening events.
OBJECTIVE
The purpose of this study was to compare accessory pathway (AP) characteristics and occurrences of sudden cardiac arrest (SCA) and rapidly conducted preexcited atrial fibrillation (RC-AF) in patients with nonpersistent and persistent preexcitation.
METHODS
Patients 21 years or younger with WPW and invasive electrophysiology study (EPS) data, SCA, or RC-AF were identified from multicenter databases. Nonpersistent preexcitation was defined as absence/sudden loss of preexcitation on electrocardiogram, Holter monitoring, or exercise stress test. RC-AF was defined as clinical preexcited atrial fibrillation with shortest preexcited R-R interval (SPERRI) ≤ 250 ms. AP effective refractory period (APERP), SPERRI at EPS , and shortest preexcited paced cycle length (SPPCL) were collected. High-risk APs were defined as APERP, SPERRI, or SPPCL ≤ 250 ms.
RESULTS
Of 1589 patients, 244 (15%) had nonpersistent preexcitation and 1345 (85%) had persistent preexcitation. There were no differences in sex (58% vs 60% male; P=.49) or age (13.3±3.6 years vs 13.1±3.9 years; P=.43) between groups. Although APERP (344±76 ms vs 312±61 ms; P<.001) and SPPCL (394±123 ms vs 317±82 ms; P<.001) were longer in nonpersistent vs persistent preexcitation, there was no difference in SPERRI at EPS (331±71 ms vs 316±73 ms; P=.15). Nonpersistent preexcitation was associated with fewer high-risk APs (13% vs 23%; P<.001) than persistent preexcitation. Of 61 patients with SCA or RC-AF, 6 (10%) had nonpersistent preexcitation (3 SCA, 3 RC-AF).
CONCLUSION
Nonpersistent preexcitation was associated with fewer high-risk APs, though it did not exclude the risk of SCA or RC-AF in children with WPW.
背景
沃-帕-怀（Wolff-Parkinson-White，WPW）综合征患者非侵入性评估时出现心室预激突然消失（非持续性预激），或预激持续存在（持续性预激），被认为发生危及生命事件的风险较低。
目的
本研究旨在比较非持续性预激和持续性预激患者的旁路（AP）特征及心脏骤停（SCA）和快速传导的预激性心房颤动（RC-AF）的发生情况。
方法
从多中心数据库中确定了 21 岁或以下的 WPW 患者，这些患者进行了经导管电生理检查（EPS）、SCA 或 RC-AF。非持续性预激定义为心电图、动态心电图监测或运动应激试验上预激缺失/突然消失。RC-AF 定义为具有最短预激 R-R 间期（SPERRI）≤250ms 的临床预激性心房颤动。收集旁路有效不应期（APERP）、EPS 时的 SPERRI 和最短预激程控刺激周期长度（SPPCL）。高危旁路定义为 APERP、SPERRI 或 SPPCL≤250ms。
结果
在 1589 例患者中，244 例（15%）存在非持续性预激，1345 例（85%）存在持续性预激。两组间性别（58% vs 60%男性；P=0.49）或年龄（13.3±3.6 岁 vs 13.1±3.9 岁；P=0.43）均无差异。虽然非持续性预激的 APERP（344±76ms vs 312±61ms；P<.001）和 SPPCL（394±123ms vs 317±82ms；P<.001）较长，但 EPS 时的 SPERRI 无差异（331±71ms vs 316±73ms；P=0.15）。非持续性预激与较少的高危旁路（13% vs 23%；P<.001）相关。在 61 例 SCA 或 RC-AF 患者中，有 6 例（10%）存在非持续性预激（3 例 SCA，3 例 RC-AF）。
结论
尽管 WPW 患儿中存在非持续性预激并不排除发生 SCA 或 RC-AF 的风险，但它与较少的高危旁路相关。
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