Ten years of transesophageal electrophysiological studies in younger than 40 years people with a wolff-parkinson-white syndrome

Abstract Background The electrophysiological evaluation of Wolff–Parkinson–White syndrome (WPW) is recommended in people older than five–years to detect the risk of life–threatening arrhythmias. The purpose of this retrospective single–center study was to determine the feasibility of transesophageal electrophysiological study (EPS) in an outpatient setting among young people between 10 and 37 years old and to evaluate its prognostic role. Methods Electrophysiological study (EPS) was indicated in 60 consecutive people (48 males, 81%; mean age 19 ± 7 years) between january 2012 and october 2023. The test was indicated for manifest WPW, either for palpitations (n=11, 18.6%), unexplained dizziness (n=1, 1.7%), or for sport eligibility in asymptomatic people (n=47, 79.6%). An accessory pathway (AP) was considered to have a short refractory period and carry an increased risk for sudden cardiac death when the effective refractory period (ERP) was ≤240 ms, or if an atrioventricular (AV) reentrant tachycardia precipitating pre–excited atrial fibrillation was induced. Results EPS was performed in all but one person, without sedation. The main difficulty lied in passing the catheter through the nose. Programmed atrial stimulation at cycle length of 500 ms with one decremental extrastimulus was performed in all people to determinate the refractory period of the AP and the AV node. Physical activity during the test, or isoproterenol infusion was performed in 45 out of 59 people. The AP ERP was determined in the majority of case (54 out 59 people) and was between 200 and 360 ms (mean 270 ± 34 ms). Orthodromic reentrant tachycardia was induced in 10 (16.9%) cases, in 5 asymptomatic people and 5 patients with palpitations. Atrial fibrillation was induced in 13 cases. Antidromic tachycardia was never induced. Ten people (16.9%) were deemed at increased risk of life–threatening arrhythmias while 49 (83.1%) patients were deemedat low risk. Eight out of 10 (80%) high risk pts and only 5 out of 49 low risk patientss underwent catheter ablation of the AP. After a median follow–up of 57 months, all 49 patients defined at low risk were alive, without syncope or sudden cardiac arrest events. Conclusions In young patients with WPW syndrome, transesophageal EPS can be performed in an outpatient setting with an excellent tolerability and shows a high specificity (negative predictive value of 100%) to role out patients at increased risk of life–threatening arrhythmias.