ELECTROCARDIOGRAPHIC AND ELECTROPHYSIOLOGICAL CHARACTERISTICS OF FASCICULOVENTRICULAR FIBERS IN CHILDREN: SINGLE-CENTER 8-YEARS EXPERIENCE

Sülü A., Kafalı H. C., Şahin G. T., Güzeltaş A., Ergül Y.

AEPC 2022 - 55th Annual Meeting of the Association for European Paediatric and Congenital Cardiology , Geneve, İsviçre, 25 Mayıs 2022, ss.146

  • Yayın Türü: Bildiri / Tam Metin Bildiri
  • Basıldığı Şehir: Geneve
  • Basıldığı Ülke: İsviçre
  • Sayfa Sayıları: ss.146
  • Eskişehir Osmangazi Üniversitesi Adresli: Evet

Özet

Arrhythmia / Electrophysiology

ELECTROCARDIOGRAPHIC AND ELECTROPHYSIOLOGICAL CHARACTERISTICS OF

FASCICULOVENTRICULAR FIBERS IN CHILDREN: SINGLE-CENTER 8-YEARS EXPERIENCE

Ayse Sulu1, Hasan Candas Kafali1, Gulhan Tunca Sahin2, Alper Guzeltas1, Yakup Ergul1

1Department of Pediatric Cardiology, Saglik Bilimleri University M. Akif Ersoy Thoracic and

Cardiovascular Surgery Center, Istanbul, Turkey

2Department of Pediatric Cardiology, Saglik Bilimleri University Cam and Sakura Hospital, Istanbul,

Turkey

BACKGROUND AND AIM: Fasciculoventricular fiber (FVF) is a rare cause of ventricular preexcitation.

Although adenosine response and some electrocardiographic features are important in differentiate

from Wolf Parkinson White (WPW), a clear distinction may not always be possible without an

electrophysiological study (EPS). In this study, our aim is to evaluate the clinical and

electrophysiological features of our pediatric patients with FVFs.

METHODS: In this study, FVF was detected in 27 (4.7%) of 565 patients who underwent

electrophysiological study due to ventricular preexcitation between 2013-2021. The demographic

characteristics of the patients were obtained from the file records. In addition, delta wave

amplitudes were measured from the surface ECG before and after ablation in patients with

additional accessory pathways. Post-procedure values were included in the FVF data.

RESULTS: The mean age of the patients was 11.47±4.25 years. 70.4% of the reasons for admission

were symptoms such as palpitations and syncope. Two patients had hypertrophic cardiomyopathy

and one patient had ccTGA. In the EPS, additional manifest WPW was found in 9 (33%) patients (3

patients with high risk), focal atrial tachycardia in one patient, and atrioventricular nodal reentrant

tachycardia in another patient (totally 11/27 ). While the delta wave amplitude in surface

electrocardiography was 2.56±1.38(1-5.5)mm in 9 patients with additional accessory pathway, it was

1.64±0.67(0.5-3) mm in the FVF group. Delta amplitude >3.5mm was not detected in any patient

with isolated FVF. Interestingly, delta amplitude was <3.5mm in 7 of 9 patients in whom additional

accessory pathways were identified and ablated. Nineteen of the patients (59.3%) were adenosineresponsive

(18 isolated FVF, 1 manifest AP+FVR responsive to adenosine).

CONCLUSIONS: Although the FVF are not the cause of tachyarrhythmia, the accessory pathway and

other tachyarrhythmia substrate frequencies accompanying these cases are quite high

(approximately 40%) in EPS. The delta wave characteristics of ablated patients are very similar to FVF

patients. Although the adenosine response is important, is not definitively distinctive. Therefore,

performing EPS in patients (especially symptomatic) with suspected FVF based on surface ECG

features seems to be important for the detection of additional tachyarrhythmias and risky accessory

pathways.

Keywords: Fasciculoventricular fiber, electrophysiological study, WPW, ablation