Should patients with asymptomatic wolff-parkinson-white pattern undergo a catheter ablation?

Abstract

Many individuals with the Wolff-Parkinson-White electrocardiographic pattern are asymptomatic. Optimal management of these individuals is still a matter of debate. On the one hand, sudden cardiac death from ventricular fibrillation is a rare yet possible outcome in these individuals. On the other hand, there is a low risk of serious complication from electrophysiologic study and ablation. Given that the risk of these competing strategies is comparable, the decision needs to be individualized with considerable patient input.

Risk Stratification in Wolff‐Parkinson‐White Syndrome: The Correlation Between Noninvasive and Invasive Testing in Pediatric Patients

“…In the current era, however, with the improved safety profile of and experience with radiofrequency and cryoablation, it is increasingly common practice to proceed with ablation of APs thought to be low‐risk without inducible SVT. The value of noninvasive risk stratification has also been called into question 28–31 …”

“…The value of noninvasive risk stratification has also been called into question. [28][29][30][31] The yield of any noninvasive testing to detect nonrapid AP conduction in our cohort was 18%, with 21% of patients who underwent EST demonstrating abrupt loss of preexcitation. These data are very similar to that found by Fazio et al 13 in a recent pediatric study of 124 patients, where 15% had intermittent preexcitation on Holter monitoring and 21% had abrupt disappearance of the delta wave with EST.…”