Usefulness of invasive electrophysiologic testing to stratify the risk of arrhythmic events in asymptomatic patients with Wolff-Parkinson-White pattern: Results from a large prospective long-term follow-up study

Carlo Pappone, Vincenzo Santinelli, Salvatore Rosanio, Gabriele Vicedomini, Stefano Nardi, Alessia Pappone, Valter Tortoriello, Francesco Manguso, Patrizio Mazzone, Simone Gulletta, Giuseppe Oreto, Ottavio Alfieri

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)239-244
Number of pages6
JournalJournal of the American College of Cardiology
Volume41
Issue number2
DOIs
Publication statusPublished - Jan 15 2003

ASJC Scopus subject areas

  • Nursing(all)

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