Asymptomatic Ventricular Preexcitation: A Long-Term Prospective Follow-Up Study of 293 Adult Patients
Open accessAbstract
BACKGROUND: Sudden cardiac death can be the first clinical presentation of asymptomatic ventricular preexcitation. METHODS AND RESULTS: From 1995 to 2005, we prospectively collected clinical and electrophysiological data among 293 adults with asymptomatic ventricular preexcitation (61.4% males; median age, 36 years; interquartile range [IQR], 28 to 47.5). After electrophysiological testing, patients were prospectively followed, taking no drugs. The primary end point of the study was the occurrence of a first arrhythmic event. Predictors of arrhythmic events were analyzed by univariate and multivariate Cox models. Over a median follow-up of 67 months (minimum to maximum, 8 to 90), after electrophysiological testing, 262 patients (median age, 37 years; IQR, 30 to 48) did not experience arrhythmic events, remaining totally asymptomatic, whereas 31 patients (median age, 25 years; IQR, 22 to 29; median follow-up, 27 months; minimum to maximum, 8 to 55) had a first arrhythmic event, which was potentially life-threatening in 17 of them (median age, 24 years; IQR, 20 to 28.5; median follow-up, 25 months; minimum to maximum, 9 to 55). Potentially life-threatening tachyarrhythmias resulted in resuscitated cardiac arrest (1 patient), presyncope (7 patients) syncope (4 patients), or dizziness (5 patients). In multivariate analysis age (P=0.004), inducibility (P=0.001) and anterograde effective refractory period of the accessory pathway < or = 250 ms (P=0.001) predicted potentially life-threatening arrhythmias. CONCLUSIONS: These results indicate that prognosis of adults who present with asymptomatic ventricular preexcitation is good, and the risk of a significant event is small. Short anterograde effective refractory period of the accessory pathway and inducibility at baseline are independent predictors of potentially life-threatening arrhythmic events, and the risk decreases with increasing age.
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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 [341]
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 [341]
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- Authors
- Santinelli, V., Radinovic, A., Manguso, F., Vicedomini, G., Ciconte, G., Gulletta, S., Paglino, G., Sacchi, S., Sala, S., Ciaccio, C., & Pappone, C.
- Affiliations
- IRCCS Ospedale San Raffaele (IT)
- ORCID
- Venue
- Circulation Arrhythmia and Electrophysiology
- Published
- 2009-04
- Volume
- 2
- Issue
- 2
- Pages
- 102-107
- ISSN
- 1941-3084 (ISSN-L)
- 1941-3149
- OpenAlex
- W2121914468
- Cited by
- 83
- References
- 32
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 4 · 2022: 2 · 2021: 6 · 2020: 4 · 2019: 4 · 2018: 2 · 2017: 2 · 2016: 4 · 2015: 9 · 2014: 2 · 2013: 8 · 2012: 13
- FWCI
- 6.84
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation Arrhythmia and Electrophysiology (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 › Cardiac pacing and defibrillation studies
- Keywords
- Wolff-Parkinson-White syndrome, sudden cardiac death, arrhythmic events, accessory pathway, risk prediction, age, syncope, tachyarrhythmias
- MeSH terms
- Adult, Female, Follow-Up Studies, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Refractory Period, Electrophysiological, Risk Factors, Wolff-Parkinson-White Syndrome, Multivariate Analysis, Proportional Hazards Models, Death, Sudden, Cardiac, Catheter Ablation, Young Adult
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