Anesthetic Technique for Transesophageal Electrophysiology Studies in Pediatric Patients with Wolff-Parkinson-White Syndrome


Objective: Patients with Wolff-Parkinson-White (WPW) Syndrome require risk assessment to determine their potential for sudden cardiac death. Transesophageal electrophysiology studies (TEEPS) are an effective risk stratification tool. The purpose of this study is to describe a minimially invasive, effective anesthetic technique to employ during transesophageal electrophysiology studies. Methods: A retrospective review of anesthetic technique utilized during TEEPS. Inclusion criteria; WPW on ECG; age <18 years; and no history of tachycardia, palpitations, or syncope and patient had TEEPS under monitored anesthesia care (MAC). Midazolam, Fentanyl, and Propofol were used in various combinations. Sevoflurane was used during induction period in all GA cases and discontinued 10 minutes prior to initiation of TEEPS. Results: Inclusion criteria were met by 20 patients with an average age of 11.9 years, average weight of 48.9 kg and average height of 149.2 cm. IV sedation was performed on 15%, MAC on 10% and GA in remainder. Airway management techniques included 13.3% LMA, 20% endotrachael tube (ETT) and 66% mask. IV sedation, the initial anesthetic, was found to be cumbersome and uncomfortable. Next was ETT and LMA but trouble pacing was encountered due to positional change of the esophagus relative to the left atrium during ventilation. Mask induction was then performed in remaining 10 patients with TEEPS probe inserted through a nare while anesthesiologist continued mask ventilation. All mask procedures were successful without complications. Conclusions: Induction of anesthesia to perform TEEPS procedures on pediatric patients with Wolff-Parkinson-White syndrome underwent numerous attempts to make the procedure easy, reliable and reproducible for anesthesia and electrophysiologist. The eventual technique that proved to meet these criteria during a transesopheagel electrophysiology procedure was utilization of mask induction with continuous IV sedation.

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Gilly, G. , Hoyt, W. , Harmon, D. , Busch, E. , Nossaman, B. , Broussard, D. and Snyder, C. (2015) Anesthetic Technique for Transesophageal Electrophysiology Studies in Pediatric Patients with Wolff-Parkinson-White Syndrome. Open Journal of Pediatrics, 5, 17-22. doi: 10.4236/ojped.2015.51004.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Wolff, L., Parkinson, J. and White, P.D. (1930) Bundle Branch Block with Short PR Interval in Healthy Young People Prone to Paroxysmal Tachycardia. American Heart Journal, 5, 686-692.
[2] Hoyt, W.J., Thomas, P.E., DeSena, H.C., Steinberg, J.S., Harmon, D.E. and Snyder, C.S. (2012) Atrial Fibrillation Induction by Transesophageal Electrophysiology Studies in Patients with Asymptomatic Ventricular Preexcitation. Congenital Heart Disease, 8, 57-61.
[3] Lavoie, J., Walsh, E.P., Burrows, F.A., Laussen, P., Lulu, J.A. and Hansen, D.D. (1995) Effects of Propofol or Isoflurane Anesthesia on Cardiac Conduction in Children Undergoing Radiofrequency Catheter Ablation for Tachydysrhythmias. Anesthesiology, 82, 884-887.
[4] Sharpe, M.D., Dobkowski, W.B., Murkin, J.M., Klein, G. and Yee, R. (1995) Propofol Has No Direct Effect on Sinoatrial Node Function or on Normal Atrioventricular and Accessory Pathway Conduction in Wolff-Parkinson-White Syndrome during Alfentanil/Midazolam Anesthesia. Anesthesiology, 82, 888-895.
[5] Sharpe, M.D., Dobkowski, W.B., Murkin, J.M., Klein, G., Guiraudon, G. and Yee, R. (1992) Alfentanil-Midazolam Anaesthesia Has No Electrophysiological Effects upon the Normal Conduction System or Accessory Pathways in Patients with Wolff-Parkinson-White Syndrome. Canadian Journal of Anaesthesia, 39, 816-821.
[6] Sharpe, M.D., Dobkowski, W.B., Murkin, J.M., Klein, G., Guiraudon, G. and Yee, R. (1994) The Electrophysiologic Effects of Volatile Anesthetics and Sufentanil on the Normal Atrioventricular Conduction System and Accessory Pathways in Wolff-Parkinson-White Syndrome. Anesthesiology, 80, 63-70.
[7] Pecht, B., Maginot, K.R., Boramanand, N.K. and Perry, J.C. (2002) Techniques to Avoid Atrioventricular Block during Radiofrequency Catheter Ablation of Septal Tachycardia Substrates in Young Patients. Journal of Interventional Cardiac Electrophysiology, 7, 83-88.
[8] Pérez, E.R., Bartolomé, F.B., Carretero, P.S., Fernández, C.S., Mateos, E.J. and Tarlovsky, L.G. (2008) Electrophysiological Effects of Sevoflurane in Comparison with Propofol in Children with Wolff-Parkinson-White Syndrome. Rev Esp Anestesiol Reanim, 55, 26-31.
[9] Caldwell, J.C., Fong, C. and Muhyaldeen, S.A. (2010) Should Sevoflurane Be Used in the Electrophysiology Assessment of Accessory Pathways? Europace, 12, 1332-1335.
[10] Klein, G.J., Bashore, T.M., Sellers, T.D., Pritchett, E.L., Smith, W.M. and Gallagher, J.J. (1979) Ventricular Fibrillation in the Wolff-Parkinson-White Syndrome. The New England Journal of Medicine, 301, 1080-1085.
[11] Bromberg, B.I., Lindsay, B.D., Cain, M.E. and Cox, J.L. (1996) Impact of Clinical History and Electrophysiologic Characterization of Accessory Pathways on Management Strategies to Reduce Sudden Death among Children with Wolff-Parkinson-White Syndrome. Journal of the American College of Cardiology, 27, 690-695.

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