A Randomized Study of Prophylactic Catheter Ablation in Asymptomatic Patients with the Wolff–Parkinson–White Syndrome

Pappone, Carlo; Santinelli, Vincenzo; Manguso, Francesco; Augello, Giuseppe; Santinelli, Ornella; Vicedomini, Gabriele; Gulletta, Simone; Mazzone, Patrizio; Tortoriello, Valter; Pappone, Alessia; Dicandia, Cosimo; Rosanio, Salvatore

doi:10.1056/nejmoa035345

Cited by 213 publications

(109 citation statements)

References 17 publications

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“…In the present case, the shortest R-R interval was 248 msec (Fig. 2D) and the preexitation was accelerated during exercise; these findings are in agreement with the criteria for high risk of the development of ventricular fibrillation and sudden death in patients with WPW syndrome (7,18,19). Moreover, this wide QRS tachycardia was refractory to antiarrhythmic drugs.…”

Section: Discussionsupporting

confidence: 91%

Late Onset of Wolff-Parkinson-White Syndrome in a 72-year-old Man

et al. 2004

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We encountered a case of wide QRS tachycardia with chronic atrial fibrillation in Wolff-Parkinson-White syndrome. Unique features were late onset of syncope attacks associated with this tachycardia at an advanced age of 72 years old without previous documentation of WolffParkinson-White syndrome on electrocardiogram. He had a high likelihood of sudden cardiac death. Catheter ablation using CARTO TM system easily led to a successful ablation of the accessory pathway. The mechanism of late onset of the wide QRS tachycardia was attributed to possible changes of electrophysiologic properties including the atrio-ventricular node and/or the accessory pathway, and the unique location of the accessory pathway. Case ReportA 72-year-old man was admitted for evaluation of frequent syncope or fainting attacks which had suddenly begun 1 month before admission in May 2002. He easily experienced syncope attacks on exercise. Thus, his daily life activities were limited. He was taking antihypertensive drugs (5 mg of enalapril and 25 mg of atenolol), digitalis glycosides (0.125 mg of digoxin) and warfarin potassium as anticoagulant therapy for~10 years because of a history of cerebral infarction associated with hypertension and non-valvular chronic atrial fibrillation (Af). An electrocardiogram (ECG) taken 1 year prior to the admission was Af with narrow QRS complex ( Fig. 1A) with no evidence of tachycardia and delta waves (mean heart rate; 64 beats per minute, QRS; 82 msec). While the ECG taken 2 months prior to the admission showed Af with intermittent delta waves (mean heart rate; 60 beats per minute) ( Fig. 2A).On admission, his blood pressure was 102/64 mmHg and pulse rate was 124 beats per minute and irregular. When his heart rate was over 150 beats per minute on exercise, his systolic blood pressure dropped under 70 mmHg with manifestation of fainting. There were no murmurs on cardiac auscultation. Routine blood test results were almost normal except for a coagulation time. An ECG (Fig. 1B) showed wide QRS complex tachycardia (mean heart rate; 138 beats per minute, QRS; 134 msec) with a slur at the initial portion of the QRS complex. This tachycardia was suppressed by an intravenous administration of procainamide, which is known to depress the conduction of the accessory pathway (1), and resulted in a dramatic decrease of the wide QRS complex (Fig. 2B). By contrast, the tachycardia was accelerated by an intravenous application of verapamil or digitalis glycosides (Fig. 2C), which are reported to depress the conduction of the atrio-ventricular (AV) node (2, 3). With this change of ECG, the patient experienced symptoms of hypotension and notable fainting. These findings suggested that this patient might have Wolff-Parkinson-White (WPW) syndrome. A chest radiograph showed a mild increase of the cardiothoracic ratio (CTR; 54%) and two-dimensional echocardiography revealed no evidence of cardiac abnormalities except for mild dilatation of the left atrium, such as Ebstein's anomaly and mitral leaflet prolapse which are...

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Section: Discussionsupporting

confidence: 91%

Late Onset of Wolff-Parkinson-White Syndrome in a 72-year-old Man

et al. 2004

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“…U pacjentów z AF, u których stwierdzono obecność drogi dodatkowej przewodzącej w kierunku do komór, zaleca się ablację przezcewnikową drogi dodatkowej [869,870]. Zabieg ten jest bezpieczny, skuteczny i może być rozważany jako profilaktyczna strategia leczenia [871,872]. U pacjentów z AF, którzy przeżyli incydent nagłego zatrzymania krążenia, w przypadku stwierdzenia obecność drogi dodatkowej zaleca się jej pilną ablację przezcewnikową [869].…”

Section: Zespół Wolffa-parkinsona-white'aunclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,319

4,163

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“…Asymptomatic patients require periodic observation. The onset of cardiac arrhythmias, and possibly the sudden death risk, may be eliminated by prophylactic catheter ablation [7,9]. We suggest that our patients should also receive prophylactic catheter ablation.…”

Section: Discussionmentioning

confidence: 87%

“…In our case, the 12-lead ECG on admission showed SVT with a heart rate of 250 per minute. The incidence of SCD in patients with WPW syndrome has been estimated to range from 0.15% to 0.39% [7]. Risk factors for sudden death include, a short pre-excited R-R interval (< 250 ms) during spontaneous or induced atrial fi brillation (AF), history of symptomatic tachycardia, multiple accessory pathways, Ebstein's anomaly, and familial WPW syndrome [7,8].…”

Section: Discussionmentioning

confidence: 99%

Wolff-Parkinson-White Syndrome Presenting After a Motorcycle Accident

Kaya

2011

J Med Cases

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Wolff-Parkinson-White (WPW) syndrome is uncommon in emergency services, but clinicians come across patients with pre-excitation syndrome. WPW is characterized by the presence of an accessory pathway that predisposes patients to tachyarrhythmias and sudden death. Patients with WPW syndrome are potentially at an increased risk of dangerous ventricular arrhythmias. Most of the patients are young and do not have underlying structural heart disease. Management of asymptomatic patients with WPW syndrome has always remained controversial. Here, we present a rare case of a 29-year-old man with WPW syndrome after a motorcycle accident.

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A Randomized Study of Prophylactic Catheter Ablation in Asymptomatic Patients with the Wolff–Parkinson–White Syndrome

Abstract: Prophylactic accessory-pathway ablation markedly reduces the frequency of arrhythmic events in asymptomatic patients with the Wolff-Parkinson-White syndrome who are at high risk for such events.

Cited by 213 publications

References 17 publications

Late Onset of Wolff-Parkinson-White Syndrome in a 72-year-old Man

Late Onset of Wolff-Parkinson-White Syndrome in a 72-year-old Man

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Wolff-Parkinson-White Syndrome Presenting After a Motorcycle Accident

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