WPW Syndrome in the Era of Catheter Ablation: Insights From a Registry Study of 2169 Patients
What are the long-term outcomes in symptomatic and asymptomatic individuals with a Wolff-Parkinson-White (WPW) pattern on the electrocardiogram?
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.
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.
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.
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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