A randomized study of prophylactic catheter ablation in asymptomatic patients with the Wolff-Parkinson-White syndrome
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BACKGROUND: Young age and inducibility of atrioventricular reciprocating tachycardia or atrial fibrillation during invasive electrophysiological testing identify asymptomatic patients with a Wolff-Parkinson-White pattern on the electrocardiogram as being at high risk for arrhythmic events. We tested the hypothesis that prophylactic catheter ablation of accessory pathways would provide meaningful and durable benefits as compared with no treatment in such patients. METHODS: From 1997 to 2002, among 224 eligible asymptomatic patients with the Wolff-Parkinson-White syndrome, patients at high risk for arrhythmias were randomly assigned to radio-frequency catheter ablation of accessory pathways (37 patients) or no treatment (35 patients). The end point was the occurrence of arrhythmic events over a five-year follow-up period. RESULTS: Patients assigned to ablation had base-line characteristics that were similar to those of the controls. Two patients in the ablation group (5 percent) and 21 in the control group (60 percent) had arrhythmic events. One control patient had ventricular fibrillation as the presenting arrhythmia. The five-year Kaplan-Meier estimates of the incidence of arrhythmic events were 7 percent among patients who underwent ablation and 77 percent among the controls (P<0.001 by the log-rank test); the risk reduction with ablation was 92 percent (relative risk, 0.08; 95 percent confidence interval, 0.02 to 0.33; P<0.001). CONCLUSIONS: 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.
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In that first trial, 5-year Kaplan-Meier estimates of arrhythmic events were 7% after ablation and 77% in controls (P<0.001), with a risk reduction of 92% (RR 0.08; 95% CI 0.02-0.33; P<0.001).
“The 5-year Kaplan -Meier estimates of the incidence of arrhythmic events were 7% among patients who underwent ablation, and 77% among the controls (P , 0.001 by the log-rank test); the risk reduction with ablation was 92% (relative risk, 0.08; 95% CI, 0.02 to 0.33; P , 0.001).”
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 [343]
In that first trial, EP study complications developed in 3 patients (1%) (2 pneumothorax and 1 large femoral haematoma), and an ablation-related complication (permanent RBBB) developed in 1 (3%) of 37 patients.
“Complications related to EP study developed in three patients (1%) (2 pneumothorax and 1 large femoral haematoma).An ablation-related complication (permanent RBBB) developed in 1 (3%) of 37 patients.343”
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 [343]
In the first randomized trial, patients 35 years or younger with reproducibly induced arrhythmias were randomized to radiofrequency catheter ablation (37 patients) or no treatment (35 patients); 2 in the ablation group (5%) and 21 in the control group (60%) had arrhythmic events within 9-60 months.
“In the first randomized trial, patients 35 years old or younger in whom arrhythmias were reproducibly induced were randomly assigned to radiofrequency catheter ablation of accessory pathways (37 patients) or no treatment (35 patients).Two patients in the ablation group (5%) and 21 in the control group (60%) had arrhythmic events within the next 9 -60 months.”
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 [343]
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Fibrillation auriculaire compliquant un syndrome de Wolff-Parkinson-White
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- Authors
- Pappone, C., Santinelli, V., Manguso, F., Augello, G., Santinelli, O., Vicedomini, G., Gulletta, S., Mazzone, P., Tortoriello, V., Pappone, A., Dicandia, C., & Rosanio, S.
- Affiliations
- IRCCS Ospedale San Raffaele (IT)
- Federico II University Hospital (IT)
- The University of Texas Medical Branch at Galveston (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2003-11-06
- Volume
- 349
- Issue
- 19
- Pages
- 1803-1811
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2052680276
- Cited by
- 236
- References
- 17
- Citations by year
- 2026: 8 · 2025: 3 · 2024: 7 · 2023: 5 · 2022: 5 · 2021: 7 · 2020: 7 · 2019: 10 · 2018: 3 · 2017: 5 · 2016: 11 · 2015: 20 · 2014: 6 · 2013: 12 · 2012: 17
- FWCI
- 8.34
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- INFM-OAR (INFN Catania) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- Wolff-Parkinson-White syndrome, accessory pathway ablation, atrioventricular reciprocating tachycardia, atrial fibrillation, arrhythmic events, asymptomatic patients, radiofrequency ablation, ventricular fibrillation
- MeSH terms
- Adolescent, Adult, Electrocardiography, Female, Humans, Male, Middle Aged, Wolff-Parkinson-White Syndrome, Survival Analysis, Catheter Ablation, Risk Assessment, Electrophysiologic Techniques, Cardiac
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