Asymptomatic Wolff-Parkinson-White Pattern ECG in USAF Aviators

Davenport, Eddie D; Rupp, Karen A. N.; Palileo, Edwin; Haynes, Jared T

doi:10.3357/amhp.4569.2017

Cited by 10 publications

(9 citation statements)

References 0 publications

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“…Correspondingly, the SCD rate among the asymptomatic pre‐excited population is also low . It is notable that other studies also report that the majority of patients with VF are resuscitated (Table ) .…”

Section: Introductionmentioning

confidence: 87%

“…4 Correspondingly, the SCD rate among the asymptomatic preexcited population is also low. 5,6 It is notable that other studies also report that the majority of patients with VF are resuscitated (Table 2). 3,7,8 The combined risk of SCD/aborted VF is estimated Table 2) and likely to be even lower in the real-world WPW population outside of geographically unique reported studies.…”

Section: The Low Rate Of Sudden Cardiac Death Due To Wpwmentioning

confidence: 97%

“…TA B L E 2 Asymptomatic pre-excitation patients from two recent large studies reporting on death/ventricular fibrillation related to preexcitation (patients 1-13, 7 patients 14-23 9 ) demonstrating majority of VF events to be aborted and a majority to occur in the pediatric population Concerns have been raised regarding this high rate that is inconsistent with other data 5,6,13 and the very small numbers in themselves are grounds for caution in generalizability. It is critical to further note that the patient that died and two with aborted VF all had documented AF during follow-up with extremely rapid ventricular responses over multiple APs, and yet all parents of these three children declined ablation despite symptoms of loss of appetite, nausea, and tiredness potentially attributable to these arrhythmias.…”

Section: Can We Accurately Identify the Truly At Risk Patient/pathwaymentioning

confidence: 99%

“…Recommendations that rely heavily on unmatched findings specific to a unique geographical region and select populations may not be generalizable. Practitioners need to bear in mind that the reported rates of VF in the asymptomatic WPW population is low (and aborted in a majority—Table ) and likely to be even lower in the real‐world WPW population outside of geographically unique reported studies …”

Section: Introductionmentioning

confidence: 99%

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Application of the 2015 ACC/AHA/HRS guidelines for risk stratification for sudden death in adult patients with asymptomatic pre‐excitation

Obeyesekere

Klein

2017

Cardiovasc electrophysiol

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The management of the asymptomatic pre-excited patient largely hinges on risk stratification and individual patient considerations and choice. A high threshold to treat patients may lead to a small overall risk of death while a low threshold clearly leads to increased invasive testing and ablation with associated cost and procedural risk. A firm recommendation to uniformly assess all by electrophysiology study or, alternatively, reassure all is inappropriate and unjustified by data as reflected in the recent guideline recommendations. The use of noninvasive and invasive parameters to identify the potentially at-risk individual with surveillance for symptoms in those comfortable with this approach or ablation for those choosing this alternative for individual reasons remains the cornerstone of best practice.

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Section: Introductionmentioning

confidence: 87%

Section: The Low Rate Of Sudden Cardiac Death Due To Wpwmentioning

confidence: 97%

Section: Can We Accurately Identify the Truly At Risk Patient/pathwaymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Application of the 2015 ACC/AHA/HRS guidelines for risk stratification for sudden death in adult patients with asymptomatic pre‐excitation

Obeyesekere

Klein

2017

Cardiovasc electrophysiol

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“…In a recently published study from the USAF ECG library, 638 aircrew with pre-excitation (0.3% of all aircrew) were identified over a 68 year period. 47 Aircrew who developed high risk features (defined as symptoms, arrhythmia or ablation of a high-risk pathway) were compared with those who remained asymptomatic. Sixty-four of 638 individuals (10%) progressed to the combined endpoint of SCD, arrhythmia and/or ablation of a high-risk pathway with average follow-up of 10.5 years.…”

Section: Rhythm and Conduction Disturbancesmentioning

confidence: 99%

Management of cardiac conduction abnormalities and arrhythmia in aircrew

Guettler¹,

Bron

Manen

et al. 2018

Heart

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Cardiovascular diseases i are the most common cause of loss of flying licence globally, and cardiac arrhythmia is the main disqualifier in a substantial proportion of aircrew. Aircrew ii often operate within a demanding physiological environment, that potentially includes exposure to sustained acceleration (usually resulting in a positive gravitational force, from head to feet (+Gz)) in high performance aircraft. Aeromedical assessment is complicated further when trying to discriminate between benign and potentially significant rhythm abnormalities in aircrew, many of whom are young and fit, have a resultant high vagal tone, and among whom underlying cardiac disease has a low prevalence. In cases where a significant underlying aetiology is plausible, extensive investigation is often required and where appropriate should include review by an electrophysiologist. The decision regarding restriction of flying activity will be dependent on several factors including the underlying arrhythmia, associated pathology, risk of incapacitation and/or distraction, the type of aircraft operated, and the specific flight or mission criticality of the role performed by the individual aircrew.

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