Ventricular pre-excitation in asymptomatic pediatric patients and its current management

Author(s): Sanam Safi, Christian Jons, Peter Karl Jacobsen, Lars Idorn

The management of asymptomatic children with Ventricular Pre-Excitation (VPE) as well as prophylactic ablation amongst these patients has previously been less well established. Mandatory risk stratification for sudden cardiac death is now a key component of care, and due to the limitations of non-invasive methods, invasive Electrophysiology Study (EPS) has become the preferred diagnostic approach. However, since EPS lacks a 100% sensitivity and the risks associated with ablation are generally low, proceeding with catheter ablation following an invasive EPS should be considered. The decision to perform ablation should consider several factors such as the location of the Accessory Pathways (APs), the number of APs, AP conduction properties, co-existing structural heart disease, the patient’s weight/age, and family preferences. These factors must be balanced against the potential risks associated with procedural complications and the future risk of arrhythmias. The aim of this review article is to discuss the current recommendations and management of asymptomatic children with VPE and to point out the lack of evidence and the need for future research within this group of patients