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Christmyer Z, Pisupati M, Shah MJ, Srinivasan C, Vetter VL, Iyer VR, Triguba M, Janson CM. Risk Stratification in Pediatric Wolff-Parkinson-White: Practice Variation Among Pediatric Cardiologists and Electrophysiologists. Pediatr Cardiol 2023:10.1007/s00246-023-03247-1. [PMID: 37544951 DOI: 10.1007/s00246-023-03247-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Published guidelines provide recommendations for risk stratification in pediatric Wolff-Parkinson-White (WPW). There are no data on provider concordance with these guidelines. We hypothesized that significant practice variation exists between pediatric cardiologists (PC) and electrophysiologists (EP). METHOD The records of all patients, age 8 to 21 years, with a new ECG diagnosis of WPW between 1/1/2013 and 12/31/2018, from a single center, were retrospectively reviewed. Subjects were categorized on the basis of symptoms and resting ECG findings as one of the following: asymptomatic intermittent WPW, asymptomatic persistent WPW, or symptomatic WPW. The performance and results of diagnostic testing, including Holter monitor, event monitor, exercise stress test (EST), and electrophysiology study (EPS), were recorded. The primary outcome was concordance with published guidelines. A secondary outcome was documentation of a discussion of sudden cardiac death (SCD) risk. RESULTS 615 patient encounters were analyzed in 231 patients with newly diagnosed WPW pattern on ECG (56% male; mean age at diagnosis 13.9 ± 2.5 years). EP were observed to have a significantly higher rate of guideline concordance than PC (95% vs. 71%, p < 0.001). There was significant practice variation between PC and EP in the documentation of a discussion of SCD risk: 96% in EP vs. 39% in PC (p < 0.001). CONCLUSION Significant practice variation exists in the non-invasive and invasive risk stratification of pediatric WPW, with lower concordance to published guidelines amongst PC, when compared to EP. This report highlights the need to promote awareness of current WPW guidelines in the pediatric cardiology community at large.
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Affiliation(s)
- Zane Christmyer
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Meghana Pisupati
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Maully J Shah
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Chandra Srinivasan
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Victoria L Vetter
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - V Ramesh Iyer
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Mary Triguba
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Christopher M Janson
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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Bongiorni MG, Chen J, Dagres N, Estner H, Hernandez-Madrid A, Hocini M, Larsen TB, Pison L, Potpara T, Proclemer A, Sciaraffia E, Todd D, Blomstrom-Lundqvist C. EHRA research network surveys: 6 years of EP wires activity. Europace 2015; 17:1733-8. [PMID: 26589904 DOI: 10.1093/europace/euv371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Clinical practice should follow guidelines and recommendations mainly based on the results of controlled trials, which are often conducted in selected populations and special conditions, whereas clinical practice may be influenced by factors different from controlled scientific studies. Hence, the real-world setting is better assessed by the observational registries enrolling patients for longer periods of time. However, this may be difficult, expensive, and time-consuming. In 2009, the Scientific Initiatives Committee of the European Heart Rhythm Association (EHRA) has instigated a series of surveys covering the controversial issues in clinical electrophysiology (EP). With this in mind, an EHRA EP research network has been created, which included EP centres in Europe among which the surveys on 'hot topic' were circulated. This review summarizes the overall experience conducting EP wires over the past 6 years, categorizing and assessing the topics regarding clinical EP, and evaluating the acceptance and feedback from the responding centres, in order to improve participation in the surveys and better address the research needs and aspirations of the European EP community.
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Affiliation(s)
| | - Jian Chen
- Department of Clinical Science, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Nikolaos Dagres
- Second Cardiology Department, Attikon University Hospital, University of Athens, Athens, Greece
| | - Heidi Estner
- Department of Cardiology Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München, Germany
| | - Antonio Hernandez-Madrid
- Cardiology Department, Ramon y Cajal Hospital, Alcalá University, CarreteraColmenar Viejo, Madrid 28034, Spain
| | - Meleze Hocini
- HôpitalCardiologique du Haut Lévêque Université Victor Segalen Bordeaux II, Bordeaux, Pessac 33604, France
| | - Torben Bjerregaard Larsen
- Department of Cardiology, Cardiovascular Research Centre, Aalborg University Hospital, Aalborg, Denmark
| | - Laurent Pison
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tatjana Potpara
- School of Medicine, University of Belgrade, Serbia and Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Alessandro Proclemer
- Division of Cardiology, University Hospital S. Maria della Misericordia, IRCAB Foundation Udine, Udine, Italy
| | - Elena Sciaraffia
- Department of Cardiology, Institution of Medical Science, Uppsala University, Uppsala 75185, Sweden
| | - Derick Todd
- Institute of Cardiovascular Medicine and Science Liverpool Heart & Chest Hospital, UK
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Pappone C, Vicedomini G, Manguso F, Saviano M, Baldi M, Pappone A, Ciaccio C, Giannelli L, Ionescu B, Petretta A, Vitale R, Cuko A, Calovic Z, Fundaliotis A, Moscatiello M, Tavazzi L, Santinelli V. Wolff-Parkinson-White syndrome in the era of catheter ablation: insights from a registry study of 2169 patients. Circulation 2014; 130:811-9. [PMID: 25052405 DOI: 10.1161/circulationaha.114.011154] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The management of Wolff-Parkinson-White is based on the distinction between asymptomatic and symptomatic presentations, but evidence is limited in the asymptomatic population. METHODS AND RESULTS The Wolff-Parkinson-White registry was an 8-year prospective study of either symptomatic or asymptomatic Wolff-Parkinson-White patients referred to our Arrhythmology Department for evaluation or ablation. Inclusion criteria were a baseline electrophysiological testing with or without radiofrequency catheter ablation (RFA). Primary end points were the percentage of patients who experienced ventricular fibrillation (VF) or potentially malignant arrhythmias and risk factors. Among 2169 enrolled patients, 1001 (550 asymptomatic) did not undergo RFA (no-RFA group) and 1168 (206 asymptomatic) underwent ablation (RFA group). There were no differences in clinical and electrophysiological characteristics between the 2 groups except for symptoms. In the no-RFA group, VF occurred in 1.5% of patients, virtually exclusively (13 of 15) in children (median age, 11 years), and was associated with a short accessory pathway antegrade refractory period (P<0.001) and atrioventricular reentrant tachycardia initiating atrial fibrillation (P<0.001) but not symptoms. In the RFA group, ablation was successful in 98.5%, and after RFA, no patients developed malignant arrhythmias or VF over the 8-year follow-up. Untreated patients were more likely to experience malignant arrhythmias and VF (log-rank P<0.001). Time-dependent receiver-operating characteristic curves for predicting VF identified an optimal anterograde effective refractory period of the accessory pathway cutoff of 240 milliseconds. CONCLUSIONS The prognosis of the Wolff-Parkinson-White syndrome essentially depends on intrinsic electrophysiological properties of AP rather than on symptoms. RFA performed during the same procedure after electrophysiological testing is of benefit in improving the long-term outcomes.
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Affiliation(s)
- Carlo Pappone
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.).
| | - Gabriele Vicedomini
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Francesco Manguso
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Massimo Saviano
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Mario Baldi
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Alessia Pappone
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Cristiano Ciaccio
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Luigi Giannelli
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Bogdan Ionescu
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Andrea Petretta
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Raffaele Vitale
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Amarild Cuko
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Zarko Calovic
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Angelica Fundaliotis
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Mario Moscatiello
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Luigi Tavazzi
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
| | - Vincenzo Santinelli
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.)
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