Cited by 236Cardiac Arrhythmias and TreatmentsAtrial Fibrillation Management and OutcomesCardiac electrophysiology and arrhythmias

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A randomized study of prophylactic catheter ablation in asymptomatic patients with the Wolff-Parkinson-White syndrome

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Pappone, Carlo, Santinelli, Vincenzo, Manguso, Francesco, Augello, Giuseppe, Santinelli, Ornella, Vicedomini, Gabriele, Gulletta, Simone, Mazzone, Patrizio, Tortoriello, Valter, Pappone, Alessia, Dicandia, Cosimo, Rosanio, Salvatore·2003·New England Journal of Medicine

DOI 10.1056/nejmoa035345

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Abstract

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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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)
ORCID: Pappone, Carlo
Santinelli, Vincenzo
Manguso, Francesco
Vicedomini, Gabriele
Mazzone, Patrizio
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
DOI: 10.1056/nejmoa035345
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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A randomized study of prophylactic catheter ablation in asymptomatic patients with the Wolff-Parkinson-White syndrome

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