Usefulness of invasive electrophysiologic testing to stratify the risk of arrhythmic events in asymptomatic patients with Wolff-Parkinson-White pattern
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Objectives The aim of this study was to assess in a large cohort of asymptomatic subjects with Wolff-Parkinson-White (WPW) pattern the usefulness of invasive electrophysiologic testing (EPT) in predicting the occurrence of arrhythmic events over a five-year follow-up.Background Sudden death may be the first clinical manifestation of the WPW syndrome in previously asymptomatic patients. Serial EPTs have been proposed to identify patients at risk.Methods A total of 212 consecutive asymptomatic WPW patients were enrolled after a baseline EPT; patients were followed for five years, and 162 patients (115 noninducible and 47 inducible) patients underwent a second EPT.Results After a mean follow-up of 37.7 months, 33 patients became symptomatic. Of the 115 noninducible patients, 18.2% lost anterograde accessory pathway (AP) conduction, 30% retrograde AP conduction, and only 4 (3.4%) developed symptomatic supraventricular tachycardia (SVT). Of the 47 inducible patients, 25 with sustained atrioventricular reciprocating tachycardia (AVRT) and atrial fibrillation (AF), and 4 with nonsustained AVRT and AF became symptomatic for SVT (n = 21) and AF (n = 8). They were younger, had shorter AP anterograde refractory periods, and multiple APs compared to patients who remained asymptomatic (for all comparisons, p < 0.0001). Of the eight patients with symptomatic episodes of AF and inducible sustained AF, two had a resuscitated cardiac arrest and one died suddenly; all three patients were inducible for AVRT and AF and had multiple APs.Conclusions In asymptomatic WPW subjects, EPT may be a valuable tool to stratify the risk of symptomatic and fatal arrhythmic events.
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Available large data support the usefulness of electrophysiologic testing to identify asymptomatic WPW patients at high risk of ventricular fibrillation to prevent sudden death.
“Thus, available large data support the usefulness of electrophysiologic testing to identify those asymptomatic WPW patients at high risk of ventricular fibrillation to prevent sudden death, which in many cases can be the first clinical manifestation of the syndrome (Table 17).339 -342”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [339]
Asymptomatic patients who developed VF had short accessory pathway anterograde ERP less than 200-220 ms, and a shorter pre-excited RR interval during AF (SPERRI) less than 200-230 ms.
“Asymptomatic patients who developed VF had short accessory pathway anterograde ERP less than 200 -220 ms, and a shorter pre-excited RR interval during AF (SPERRI) less than 200 -230 ms.339,341”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [339]
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- Authors
- Pappone, C., Santinelli, V., Rosanio, S., Vicedomini, G., Nardi, S., Pappone, A., Tortoriello, V., Manguso, F., Mazzone, P., Gulletta, S., Oreto, G., & Alfieri, O.
- Affiliations
- IRCCS Ospedale San Raffaele (IT)
- Corresponding author
- Pappone, Carlo
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2003-01
- Volume
- 41
- Issue
- 2
- Pages
- 239-244
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2108699626
- Cited by
- 276
- References
- 18
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 9 · 2023: 4 · 2022: 6 · 2021: 7 · 2020: 13 · 2019: 6 · 2018: 5 · 2017: 7 · 2016: 11 · 2015: 23 · 2014: 7 · 2013: 18 · 2012: 29
- FWCI
- 9.70
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Keywords
- Wolff-Parkinson-White syndrome, asymptomatic patients, arrhythmic risk stratification, accessory pathway, atrioventricular reciprocating tachycardia, atrial fibrillation, sudden cardiac death, cardiac arrest, accessory pathway refractory period, multiple accessory pathways, supraventricular tachycardia
- MeSH terms
- Adolescent, Adult, Atrial Fibrillation, Child, Electrocardiography, Female, Follow-Up Studies, Heart Conduction System, Humans, Male, Middle Aged, Prospective Studies, Sensitivity and Specificity, Wolff-Parkinson-White Syndrome, Survival Analysis, Electrophysiologic Techniques, Cardiac
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