HRCR January 2020 Quiz

Editorial note: The following quiz is related to the article A proposed approach to the asymptomatic pediatric patient with Wolff-Parkinson-White by Chubb and Ceresnak from the January 2020 issue of Heart Rhythm Case Reports.

Question 1: Which of the following is a Class III indication for ablation of an accessory pathway in a child with asymptomatic Wolff-Parkinson-White (WPW)?

a. Mid-septal pathway with shortest pre-excited interval on atrial pacing (SPERRI-Ap) of 250ms
b. Fasciculoventricular pathway with shortest pre-excited interval in AF (SPERRI-AF) of 240ms
c. Anteroseptal pathway with SPERRI-Ap of 340ms and no inducible tachycardia
d. Two suspected pathways with two distinct but intermittent pre-excitation patterns on 12-lead ECG and structurally normal heart
e. Left lateral pathway with SPERRI-Ap of 440ms, no inducible tachycardia, and no PFO

Question 2: According to best available studies, which of the following statements regarding the risk of sudden cardiac death in the context of asymptomatic WPW is true?

a. The risk is higher in males
b. The risk is higher in adults than in children
c. The risk is approximately 1 per 10,000 patient years
d. It is very important to explore the history in detail for palpitations, as prior palpitations are associated with a higher risk of SCD
e. The risk is negligible in children under 12 years

Question 3: Which of the following best describes the accessory pathway effective refractory period (AP-ERP), on pacing from the high right atrium (HRA) in the above figure?

a. 269 msec
b. 256 msec
c. <256 msec
d. 220 msec
e. <220msec
f. 210 msec

Question 4: Which of the following approaches is not appropriate for children with asymptomatic WPW?

a. Ablation of a mid-septal pathway via the non-coronary cusp
b. Separate arterial access to perform coronary angiography to detail right coronary artery anatomy prior to ablation of a postero-septal pathway with earliest retrograde atrial activation within the coronary venous system
c. Cryoablation of a mid-septal pathway in a 15kg patient with Ebstein’s Anomaly
d. Routine invasive investigation at 3 years of age (or >10kg) in order to avoid interference with schooling
e. Re-testing with isoproterenol in a patient with a septal pathway and SPERRI-AF 280ms.