背景:已发布的指南为儿童Wolff-Parkinson-White(WPW)的风险分层提供了建议。没有关于提供者与这些准则的一致性的数据。我们假设儿科心脏病专家(PC)和电生理学家(EP)之间存在明显的实践差异。
方法:所有患者的记录,年龄8到21岁,在2013年1月1日至2018年12月31日之间的新心电图诊断为WPW,来自单个中心,进行回顾性审查。根据症状和静息心电图结果将受试者分类为以下之一:无症状间歇性WPW,无症状持续性WPW,或有症状的WPW。诊断测试的性能和结果,包括Holter监护仪,事件监视器,运动压力测试(EST),和电生理研究(EPS),被记录下来。主要结果与已发布的指南一致。次要结果是关于心脏性猝死(SCD)风险的讨论。
结果:在231例新诊断为心电图WPW模式的患者中,对615例患者的遭遇进行了分析(男性占56%;诊断时的平均年龄为13.9±2.5岁)。观察到EP的指南一致性明显高于PC(95%vs.71%,p<0.001)。在SCD风险讨论的文档中,PC和EP之间存在显着的实践差异:EP与EP的96%在PC中39%(p<0.001)。
结论:儿科WPW的非侵入性和侵入性风险分层存在显著的实践差异,与PC中已发布的指南的一致性较低,与EP相比。该报告强调了在整个儿科心脏病学界提高对当前WPW指南的认识的必要性。
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).
METHODS: 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).
CONCLUSIONS: 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.