WPW Syndrome in the Era of Catheter Ablation: Insights From a Registry Study of 2169 Patients

Study Questions:

What are the long-term outcomes in symptomatic and asymptomatic individuals with a Wolff-Parkinson-White (WPW) pattern on the electrocardiogram?

Methods:

The subjects of this cohort study were 2,169 patients (mean age 19 years) who were enrolled in a prospective WPW registry and who underwent electrophysiologic testing that included attempts at induction of atrial fibrillation (AF). All patients were followed for a minimum of 3 years. The primary endpoints were the occurrence of cardiac arrest or a malignant arrhythmia (MA), defined as AF with a shortest preexcited RR interval ≤250 ms.

Results:

Among the 1,001 patients in the no radiofrequency ablation (no-RFCA) group, 550 patients were asymptomatic and 451 had experienced symptomatic supraventricular tachycardia (SVT). During a median follow-up of 96 months, cardiac arrest occurred in 15 patients (1.5%) and MA occurred in 78 patients (7.8%), after which all patients underwent successful RFCA. The incidence of cardiac arrest in the no-RFCA group was 2.4 per 1,000 person-years. Cardiac arrest was independently associated with a short accessory pathway refractory period (optimal cut-off 240 ms) and inducible orthodromic tachycardia degenerating to AF, but not symptoms. Among the 1,168 patients in the RFCA group, the RFCA success rate was 98.5% and no patient experienced cardiac arrest or MA during follow-up.

Conclusions:

The authors concluded that in patients with a WPW pattern on the electrocardiogram, the risk of a life-threatening arrhythmia depends on the intrinsic properties of the accessory pathway, not on symptoms.

Perspective:

The results support the use of electrophysiologic testing for risk stratification and identification of appropriate RFCA candidates among asymptomatic patients with a WPW pattern.

Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Congenital Heart Disease, CHD & Pediatrics and Arrhythmias, CHD & Pediatrics and Quality Improvement

Keywords: Registries, Tachycardia, Supraventricular, Follow-Up Studies, Wolff-Parkinson-White Syndrome, Heart Conduction System, Atrial Fibrillation, Heart Arrest, Electrocardiography


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