The prognostic value of electrophysiology testing was studied in 75 asymptomatic patients with the Wolff-Parkinson-White electrocardiographic pattern. All patients underwent electrophysiology testing at entry to the study and were followed up annually for a total of 348 patient-years (median, 4.3 years). There were 44 male and 31 female patients, and age at enrollment ranged from 7 to 77 years (mean, 34±14 years). confidence interval, 1.0-1.12) were independent predictors of loss of preexcitation. This study confirms the good short-term prognosis in asymptomatic patients with the Wolff-ParkinsonWhite electrocardiographic pattern. Electrophysiology testing was of limited benefit in this group of patients owing largely to the low incidence of adverse events. (Circulation 1990;82:1718-1723 A symptomatic patients with the Wolff-Parkinson-White (WPW) electrocardiographic pattern have been considered at risk for sudden death according to studies that found that 12-27% of patients were asymptomatic before their episode of ventricular fibrillation.1,2 Patients with the WPW pattern resuscitated from sudden cardiac arrest have been found to have a specific electrophysiological profile,' and this has raised the possibility that electrophysiology testing may be used to identify asymptomatic patients at risk of sudden death. Conse-

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The implantable cardioverter defibrillator (ICD) is an established treatment for patients with life-threatening ventricular arrhythmias. While it clearly reduces the incidence of death from recurrent arrhythmia, little is known about the impact on patients' quality-of-life. In this prospective study, quality-of-life was assessed by questionnaire before and after ICD implantation. The "Sickness Impact Profile" (SIP), which evaluates physical, psychosocial, and other activities, as well as functions of daily life, was used. Employment and rehospitalization rates were also examined. Twenty-one of 23 consecutive patients, aged 58 +/- 11 years, undergoing ICD implantation at Royal Perth Hospital were studied. During the 14 +/- 8 month follow-up, 4 patients died. Functional capacity was unchanged in all but one of the survivors in whom it improved from New York Heart Association Class III to II. Four of 8 survivors employed before implant have since retired. Six patients required rehospitalization on 13 occasions, problems related to arrhythmias or the ICD. Overall SIP scores preimplant (11.2 +/- 9.3; P < 0.05) were significantly worse at 6-month follow-up (21.7 +/- 18.2), but returned to preimplant levels by 12-month follow-up (8.8 +/- 10.8; NS). This was primarily due to transient problems in the areas of emotional behavior, alertness, and social interaction. SIP psychosocial dimension scores: preimplant: 7.2 +/- 9.0; 6-month: 17.8 +/- 18.1 (P < 0.05); and 12-month: 8.6 +/- 10.3 (NS). Early retirement and hospitalizations due to arrhythmias may still be expected even after implantation of an ICD; however, quality-of-life appears only to temporarily decline.

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