Radiofrequency Ablation Prevents Lethal Arrhythmias in Children With WPW

Prophylactic radiofrequency ablation reduces the risk of life-threatening arrhythmias in children with asymptomatic Wolff-Parkinson-White syndrome (WPW), according to a report in the September 16th issue of The New England Journal of Medicine.

“The findings of this study should reassure physicians and parents alike that in children with WPW who are at high risk for arrhythmias, ablation is an appropriate option,” lead author Dr. Carlo Pappone, from San Raffaele University Hospital in Milan, Italy, and colleagues note.

The findings stem from a study of 47 children with asymptomatic WPW who were randomized to receive no treatment or to undergo radiofrequency catheter ablation. The median follow-up period was 34 months.

Catheter ablation was associated with a significant reduction in the risk of arrhythmic events. During follow-up, 12 of the 27 children (44%) in the control group experienced an arrhythmic event. By contrast, just 1 of the 20 children (5%) in the ablation group experienced such an event.

Two cases of ventricular fibrillation occurred in the control group, including one that proved fatal, the researchers note. Ablation-related complications included right bundle-branch block in two patients and pericardial effusion in one.

On multivariate analysis, not performing prophylactic ablation and the presence of multiple accessory pathways were independent predictors of an arrhythmic event, the researchers note.

“This study is important because it indicates that a WPW electrocardiogram in an asymptomatic child is not necessarily a benign finding and that a procedure can be performed to prevent an adverse outcome,” Dr. Hein J. J. Wellens, from the Cardiovascular Research Institute in Maastricht, the Netherlands, notes in a related editorial.

Still, Dr. Wellens adds that further studies are needed to determine the best approach for managing such patients.

N Engl J Med 2004;351:1172-1174,1197-1205.