Electrophysiologic Evaluation of Asymptomatic Patients with the Wolff‐Parkinson‐White Pattern

Satoh, Minoru; Aizawa, Yoshifusa; Funazaki, Toshikazu; Niwano, Shinichi; Ebe, Katsuya; Miyajima, Seiichi; Suzuki, Kaoru; Aizawa, Masami; Shibata, Akira

doi:10.1111/j.1540-8159.1989.tb02678.x

Cited by 41 publications

(24 citation statements)

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“…[12][13][14][15][16][17][18][19][20][21] Recent data have challenged the assumption that the asymptomatic WPW population is at minimal or no risk of sudden death and that RFA can be of benefit in asymptomatic subjects at risk. [21][22][23][24][25][26][27] The purpose of this study was to evaluate the long-term outcomes and predictors in a large cohort of symptomatic or asymptomatic WPW patients undergoing electrophysiological testing (EPT) using a prospective patient registry.…”

Section: September 2 2014mentioning

confidence: 99%

Wolff-Parkinson-White Syndrome in the Era of Catheter Ablation

et al. 2014

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[1][2][3][4][5][6][7][8][9][10][11] Among a large series of WPW patients resuscitated from a sudden cardiac death, more than a half had ventricular fibrillation (VF) as the sentinel event, 4 which suggests that the risk of sudden death in the asymptomatic population is indeed underrecognized.9,10 The earliest alarming reports of sudden cardiac death were published in the late 1930s, 6,7 but the clinical manifestations typically range from an abnormal ECG finding without symptoms to cardiac arrest or sudden cardiac death. Anecdotal case series on the asymptomatic Background-The management of Wolff-Parkinson-White is based on the distinction between asymptomatic and symptomatic presentations, but evidence is limited in the asymptomatic population. Methods and Results-The Wolff-Parkinson-White registry was an 8-year prospective study of either symptomatic or asymptomatic Wolff-Parkinson-White patients referred to our Arrhythmology Department for evaluation or ablation. Inclusion criteria were a baseline electrophysiological testing with or without radiofrequency catheter ablation (RFA). Primary end points were the percentage of patients who experienced ventricular fibrillation (VF) or potentially malignant arrhythmias and risk factors. Among 2169 enrolled patients, 1001 (550 asymptomatic) did not undergo RFA (no-RFA group) and 1168 (206 asymptomatic) underwent ablation (RFA group). There were no differences in clinical and electrophysiological characteristics between the 2 groups except for symptoms. In the no-RFA group, VF occurred in 1.5% of patients, virtually exclusively (13 of 15) in children (median age, 11 years), and was associated with a short accessory pathway antegrade refractory period (P<0.001) and atrioventricular reentrant tachycardia initiating atrial fibrillation (P<0.001) but not symptoms. In the RFA group, ablation was successful in 98.5%, and after RFA, no patients developed malignant arrhythmias or VF over the 8-year follow-up. Untreated patients were more likely to experience malignant arrhythmias and VF (log-rank P<0.001). Time-dependent receiver-operating characteristic curves for predicting VF identified an optimal anterograde effective refractory period of the accessory pathway cutoff of 240 milliseconds. Conclusions-The prognosis of the Wolff-Parkinson-White syndrome essentially depends on intrinsic electrophysiological properties of AP rather than on symptoms. RFA performed during the same procedure after electrophysiological testing is of benefit in improving the long-term outcomes. (Circulation. 2014;130:811-819.)

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Section: September 2 2014mentioning

confidence: 99%

Wolff-Parkinson-White Syndrome in the Era of Catheter Ablation

et al. 2014

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“…In studies reporting a mean age, the range was 32 to 50 years, [17][18][19][20]22,23 and in studies reporting a median age, the range was 19 to 36 years. [15][16][17] The majority of patients were male (range 50% to 74%).…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

“…15,16,[18][19][20][21][22][23] These 9 studies contributed data from 1818 participants (although some patients were included in >1 study), with sample sizes ranging from 29 to 550 asymptomatic patients with no ablation of the accessory pathway and from 37 to 206 asymptomatic patients with ablation of the accessory pathway. [17][18][19][20][21][22][23] All 9 studies addressed question 3, which examined the usefulness of either invasive EP study without catheter ablation of the accessory pathway or noninvasive EP study for predicting arrhythmic events in patients with asymptomatic pre-excitation.…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

“…[17][18][19][20][21][22][23] All 9 studies addressed question 3, which examined the usefulness of either invasive EP study without catheter ablation of the accessory pathway or noninvasive EP study for predicting arrhythmic events in patients with asymptomatic pre-excitation. [15][16][17][18][19][20][21][22][23] The RCT 17 component of the dual-design study also addressed question 4, which examined the efficacy of invasive EP study with catheter ablation of the accessory pathway as appropriate versus noninvasive tests with treatment or no testing/ablation as appropriate for preventing arrhythmic events and improving outcomes in patients with asymptomatic pre-excitation.…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

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Risk Stratification for Arrhythmic Events in Patients With Asymptomatic Pre-Excitation: A Systematic Review for the 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia

Al‐Khatib¹,

Arshad²,

Balk³

et al. 2016

Circulation

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Objective-To review the literature systematically to determine whether noninvasive or invasive risk stratification, such as with an electrophysiological study of patients with asymptomatic pre-excitation, reduces the risk of arrhythmic events and improves patient outcomes. Methods-PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (all January 1, 1970, through August 31, 2014 were searched for randomized controlled trials and cohort studies examining noninvasive or invasive risk stratification in patients with asymptomatic pre-excitation. Studies were rejected for low-quality design or the lack of an outcome, population, intervention, or comparator of interest or if they were written in a language other than English. Results-Of 778 citations found, 9 studies met all the eligibility criteria and were included in this paper. Of the 9 studies, 1 had a dual design-a randomized controlled trial of ablation versus no ablation in 76 patients and an uncontrolled prospective cohort of 148 additional patients-and 8 were uncontrolled prospective cohort studies (n=1594). In studies reporting a mean age, the range was 32 to 50 years, and in studies reporting a median age, the range was 19 to 36 years. The majority of patients were male (range, 50% to 74%), and <10% had structural heart disease. In the randomized controlled trial component of the dual-design study, the 5-year Kaplan-Meier estimates of the incidence of arrhythmic events were 7% among patients who underwent ablation and 77% among patients who did not undergo ablation (relative risk reduction: 0.08; 95% confidence interval: 0.02 to 0.33; P<0.001). In the observational cohorts of asymptomatic patients who did not undergo catheter ablation (n=883, with follow-up ranging from 8 to 96 months), regular supraventricular tachycardia or benign atrial fibrillation (shortest RR interval >250 ms) developed in 0% to 16%, malignant atrial fibrillation (shortest RR interval ≤250 ms) in 0% to 9%, and ventricular fibrillation in 0% to 2%, most of whom were children in the last case. Conclusions-The existing evidence suggests risk stratification with an electrophysiological study of patients with asymptomatic pre-excitation may be beneficial, along with consideration of accessory-pathway ablation in those deemed to be at high risk of future arrhythmias. Given the limitations of the existing data, well-designed and well-conducted studies are needed. (Circulation. 2016;133:e575-e586.

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“…120, 121 Patients at a high risk of transition from atrial fibrillation to VF may be identified on the basis of the refractory period of antegrade conduction over the accessory pathway or the shortest R-R interval during atrial fibrillation induced during EPS. 118,122, 123 …”

Section: Wolff-parkinson-white Syndromementioning

confidence: 99%

Guidelines for Risks and Prevention of Sudden Cardiac Death (JCS 2010) - Digest Version -

Group¹

2012

Circ J

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Electrophysiologic Evaluation of Asymptomatic Patients with the Wolff‐Parkinson‐White Pattern

Cited by 41 publications

References 14 publications

Wolff-Parkinson-White Syndrome in the Era of Catheter Ablation

Wolff-Parkinson-White Syndrome in the Era of Catheter Ablation

Risk Stratification for Arrhythmic Events in Patients With Asymptomatic Pre-Excitation: A Systematic Review for the 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia

Guidelines for Risks and Prevention of Sudden Cardiac Death (JCS 2010) - Digest Version -

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