Asymptomatic ventricular preexcitation a long-term prospective follow-up study of 293 adult patients

Vincenzo Santinelli, Andrea Radinovic, Francesco Manguso, Gabriele Vicedomini, Giuseppe Ciconte, Simone Gulletta, Gabriele Paglino, Stefania Sacchi, Simone Sala, Cristiano Ciaccio, Carlo Pappone

Research output: Contribution to journalArticle

Abstract

Background-Sudden cardiac death can be the first clinical presentation of asymptomatic ventricular preexcitation. Methods and Results-From 1995 to 2005, we prospectively collected clinical and electrophysiological data among 293 adults with asymptomatic ventricular preexcitation (61.4% males; median age, 36 years; interquartile range [IQR], 28 to 47.5). After electrophysiological testing, patients were prospectively followed, taking no drugs. The primary end point of the study was the occurrence of a first arrhythmic event. Predictors of arrhythmic events were analyzed by univariate and multivariate Cox models. Over a median follow-up of 67 months (minimum to maximum, 8 to 90), after electrophysiological testing, 262 patients (median age, 37 years; IQR, 30 to 48) did not experience arrhythmic events, remaining totally asymptomatic, whereas 31 patients (median age, 25 years; IQR, 22 to 29; median follow-up, 27 months; minimum to maximum, 8 to 55) had a first arrhythmic event, which was potentially life-threatening in 17 of them (median age, 24 years; IQR, 20 to 28.5; median follow-up, 25 months; minimum to maximum, 9 to 55). Potentially life-threatening tachyarrhythmias resulted in resuscitated cardiac arrest (1 patient), presyncope (7 patients) syncope (4 patients), or dizziness (5 patients). In multivariate analysis age (P=0.004), inducibility (P=0.001) and anterograde effective refractory period of the accessory pathway ≤250 ms (P=0.001) predicted potentially life-threatening arrhythmias. Conclusions-These results indicate that prognosis of adults who present with asymptomatic ventricular preexcitation is good, and the risk of a significant event is small. Short anterograde effective refractory period of the accessory pathway and inducibility at baseline are independent predictors of potentially life-threatening arrhythmic events, and the risk decreases with increasing age. (Circ Arrhythmia Electrophysiol. 2009;2:102-107.)

Original languageEnglish
Pages (from-to)102-107
Number of pages6
JournalCirculation: Arrhythmia and Electrophysiology
Volume2
Issue number2
DOIs
Publication statusPublished - Apr 2009

Fingerprint

Syncope
Cardiac Arrhythmias
Sudden Cardiac Death
Dizziness
Heart Arrest
Proportional Hazards Models
Tachycardia
Multivariate Analysis
Pharmaceutical Preparations

Keywords

  • Catheter ablation
  • Death
  • Sudden
  • Syncope
  • Wolff-parkinson-white syndrome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Asymptomatic ventricular preexcitation a long-term prospective follow-up study of 293 adult patients. / Santinelli, Vincenzo; Radinovic, Andrea; Manguso, Francesco; Vicedomini, Gabriele; Ciconte, Giuseppe; Gulletta, Simone; Paglino, Gabriele; Sacchi, Stefania; Sala, Simone; Ciaccio, Cristiano; Pappone, Carlo.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 2, No. 2, 04.2009, p. 102-107.

Research output: Contribution to journalArticle

Santinelli, Vincenzo ; Radinovic, Andrea ; Manguso, Francesco ; Vicedomini, Gabriele ; Ciconte, Giuseppe ; Gulletta, Simone ; Paglino, Gabriele ; Sacchi, Stefania ; Sala, Simone ; Ciaccio, Cristiano ; Pappone, Carlo. / Asymptomatic ventricular preexcitation a long-term prospective follow-up study of 293 adult patients. In: Circulation: Arrhythmia and Electrophysiology. 2009 ; Vol. 2, No. 2. pp. 102-107.
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AU - Ciconte, Giuseppe

AU - Gulletta, Simone

AU - Paglino, Gabriele

AU - Sacchi, Stefania

AU - Sala, Simone

AU - Ciaccio, Cristiano

AU - Pappone, Carlo

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N2 - Background-Sudden cardiac death can be the first clinical presentation of asymptomatic ventricular preexcitation. Methods and Results-From 1995 to 2005, we prospectively collected clinical and electrophysiological data among 293 adults with asymptomatic ventricular preexcitation (61.4% males; median age, 36 years; interquartile range [IQR], 28 to 47.5). After electrophysiological testing, patients were prospectively followed, taking no drugs. The primary end point of the study was the occurrence of a first arrhythmic event. Predictors of arrhythmic events were analyzed by univariate and multivariate Cox models. Over a median follow-up of 67 months (minimum to maximum, 8 to 90), after electrophysiological testing, 262 patients (median age, 37 years; IQR, 30 to 48) did not experience arrhythmic events, remaining totally asymptomatic, whereas 31 patients (median age, 25 years; IQR, 22 to 29; median follow-up, 27 months; minimum to maximum, 8 to 55) had a first arrhythmic event, which was potentially life-threatening in 17 of them (median age, 24 years; IQR, 20 to 28.5; median follow-up, 25 months; minimum to maximum, 9 to 55). Potentially life-threatening tachyarrhythmias resulted in resuscitated cardiac arrest (1 patient), presyncope (7 patients) syncope (4 patients), or dizziness (5 patients). In multivariate analysis age (P=0.004), inducibility (P=0.001) and anterograde effective refractory period of the accessory pathway ≤250 ms (P=0.001) predicted potentially life-threatening arrhythmias. Conclusions-These results indicate that prognosis of adults who present with asymptomatic ventricular preexcitation is good, and the risk of a significant event is small. Short anterograde effective refractory period of the accessory pathway and inducibility at baseline are independent predictors of potentially life-threatening arrhythmic events, and the risk decreases with increasing age. (Circ Arrhythmia Electrophysiol. 2009;2:102-107.)

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