Risk of Arrhythmia and Sudden Death in Patients With Asymptomatic Preexcitation: A Meta-Analysis

Study Questions:

What is the risk of sudden cardiac death (SCD) in asymptomatic individuals with a Wolff-Parkinson-White (WPW) electrocardiographic pattern?


This was a meta-analysis of 20 studies involving 1,869 asymptomatic patients (mean age 26 years) with ventricular pre-excitation followed for a mean of 15 months to 22 years. Data on the incidence of SCD and supraventricular tachycardia (SVT) were extracted from the studies.


Ten SCDs were reported in six studies. After adjustment for heterogeneity between studies, the incidence of SCD was 1.25/1,000 person-years. There was a trend toward a higher SCD rate in children (1.93/1,000 person-years) than in adults (0.86/1,000 person-years). The incidence of SCD was much higher in Italian studies (2.16/1,000 person-years) than in non-Italian studies (0.36/1,000 person-years). The incidence of SVT during follow-up was 16 events/1,000 person-years.


The authors concluded that the risk of SCD in asymptomatic individuals with a WPW pattern is low, particularly outside of Italy.


It is striking that the risk of SCD was >5 times higher in studies performed in Italy. Although a more malignant variety of WPW syndrome in Italians cannot be ruled out, it seems more likely that at least some of the patients with SCD were not truly asymptomatic at the time of initial evaluation. This emphasizes the importance of a careful and detailed history before concluding that an individual is asymptomatic. The risk of SCD as the first manifestation of WPW syndrome is too low to justify routine electrophysiological testing or catheter ablation. Because the risk of death or serious complications from catheter ablation of accessory pathways also is very low, catheter ablation in selected patients remains appropriate for issues related to occupation or anxiety.

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

Keywords: Risk, Follow-Up Studies, European Continental Ancestry Group, Electrophysiological Phenomena, Electrocardiography, Tachycardia, Italy, Child, Incidence, Pre-Excitation Syndromes, Wolff-Parkinson-White Syndrome, Death, Accessory Atrioventricular Bundle, Catheter Ablation

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