Risk of Arrhythmia and Sudden Death in Patients With Asymptomatic Preexcitation

Abstract

The low incidence of SCD and low risk of supraventricular tachycardia argue against routine invasive management in most asymptomatic patients with the Wolff-Parkinson-White ECG pattern.

When can ablation be considered a reasonable option in young asymptomatic patients with a Wolff–Parkinson–White ECG?

“…The risk of AF is low, estimated at 0.9 (95% CI: 0.3-1.8) per 100 person-years of follow-up [3]. The incidence of VF (including aborted) is lower, estimated at 0.2 (95% CI: 0.06-0.4) in children (<18 years), and even lower at 0.09 (95% CI: 0.03-0.2) in adults, per 100 patient-years of follow-up [4]. It is notable that most patients presenting with VF were probably symptomatic prior to VF (thus lending itself to earlier diagnosis and therapy).…”

“…It is notable that most patients presenting with VF were probably symptomatic prior to VF (thus lending itself to earlier diagnosis and therapy). Also when VF occurs most are aborted (~60%) [2,4,5]. The low risk of death associated with asymptomatic WPW contrasts with the incidence of sudden death in population studies of 0.003-0.02 per 100 person-years in 0-49-year-olds [4,5].…”

“…Also when VF occurs most are aborted (~60%) [2,4,5]. The low risk of death associated with asymptomatic WPW contrasts with the incidence of sudden death in population studies of 0.003-0.02 per 100 person-years in 0-49-year-olds [4,5]. The lower background sudden death rate in the general population argue for attempts to identify at-risk asymptomatic WPW individuals.…”

“…Death due to catheter ablation is reported to occur in 0.0-0.2% of cases, though this incidence may be variable in the community and may be under reported [2,4,9]. Complication rates related to invasive electrophysiological testing and ablation range from 1.8 to 8.2% [2,4].…”

“…Complication rates related to invasive electrophysiological testing and ablation range from 1.8 to 8.2% [2,4]. Serious adverse events due to catheter ablation include AV block, cardiac perforation, coronary artery injury and thromboembolic events.…”