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J Am Coll Cardiol, 2003; 41:239-244, doi:10.1016/S0735-1097(02)02706-7 © 2003 by the American College of Cardiology Foundation |
* Department of Cardiology, Electrophysiology, and Cardiac Pacing Unit, San Raffaele University Hospital, Milan, Italy
Manuscript received May 9, 2002; revised manuscript received July 24, 2002, accepted August 19, 2002.
* Reprint requests and correspondence: Dr. Carlo Pappone, Department of Cardiology, Electrophysiology, and Cardiac Pacing Unit, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy.
carlo.pappone{at}hsr.it
OBJECTIVES: The aim of this study was to assess in a large cohort of asymptomatic subjects with Wolff-Parkinson-White (WPW) pattern the usefulness of invasive electrophysiologic testing (EPT) in predicting the occurrence of arrhythmic events over a five-year follow-up.
BACKGROUND: Sudden death may be the first clinical manifestation of the WPW syndrome in previously asymptomatic patients. Serial EPTs have been proposed to identify patients at risk.
METHODS: A total of 212 consecutive asymptomatic WPW patients were enrolled after a baseline EPT; patients were followed for five years, and 162 patients (115 noninducible and 47 inducible) patients underwent a second EPT.
RESULTS: After a mean follow-up of 37.7 months, 33 patients became symptomatic. Of the 115 noninducible patients, 18.2% lost anterograde accessory pathway (AP) conduction, 30% retrograde AP conduction, and only 4 (3.4%) developed symptomatic supraventricular tachycardia (SVT). Of the 47 inducible patients, 25 with sustained atrioventricular reciprocating tachycardia (AVRT) and atrial fibrillation (AF), and 4 with nonsustained AVRT and AF became symptomatic for SVT (n = 21) and AF (n = 8). They were younger, had shorter AP anterograde refractory periods, and multiple APs compared to patients who remained asymptomatic (for all comparisons, p < 0.0001). Of the eight patients with symptomatic episodes of AF and inducible sustained AF, two had a resuscitated cardiac arrest and one died suddenly; all three patients were inducible for AVRT and AF and had multiple APs.
CONCLUSIONS: In asymptomatic WPW subjects, EPT may be a valuable tool to stratify the risk of symptomatic and fatal arrhythmic events.
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