Abstract Body (Do not enter title and authors here): Background: Social determinants of health —including socioeconomic status, race and ethnicity, and access to care—affect health outcomes and contribute to disparities in disease burden and treatment. We sought to describe racial and ethnic differences in pediatric WPW patients (pts), focusing on healthcare utilization, management, and life-threatening events (LTEs) using a multicenter registry.


Methods: Data were extracted from the international ambispective WPW registry, which enrolled pts age < 21 years (2017- 2024). Demographics, clinical presentation, ED visits, hospital/ICU admissions, antiarrhythmic use, and EP study (EPS) (transesophageal and/or invasive) were compared by race (White vs. non-White) and ethnicity (Hispanic vs. non-Hispanic). LTEs were defined as sudden death (SD), aborted SD, or pre-excited AF with rapid conduction or hemodynamic instability. Logistic regression model adjusting for age at enrollment was performed to evaluate associations between race and total and invasive EPS rates.

Results: 1118 pts from 23 centers were included. Racial distribution was White (87%), Black (6%), Asian (3%), others (1%), and > 1 race (3%). Most pts with reported ethnicity were non-Hispanic (NH) (93%). Compared to White pts, non-White pts were more likely to have congenital heart disease and persistent pre-excitation but less likely to require ICU admission or undergo EPS, including invasive EPS (Table 1). There were no significant racial differences in age at presentation at EPS, symptoms at presentation, hospitalization, antiarrhythmic drug use, or LTEs at presentation or f/u. In logistic regression models adjusting for age at enrollment, race was not significantly associated with invasive EPS (p=0.067). However, White pts were significantly more likely to undergo any EPS than non-White pts (OR 1.82, 95% CI 1.05–3.14). With respect to ethnicity, Hispanic pts underwent EPS at a younger age than NH pts (12.13 vs. 13.28 yrs, p=0.033). There were no other significant management or outcome differences between ethnic groups.

Conclusion: Racial disparities in healthcare utilization and management strategies exist among pediatric WPW pts, with non-White pts less likely to undergo any EPS despite higher rates of persistent pre-excitation. Rates of LTE, however, were similar between racial and ethnic groups. Future studies should focus on exploring causes of racial disparities that would inform targeted interventions to promote equitable care.