Wolff-Parkinson-White Syndrome in the Era of Catheter Ablation: Insights From a Registry Study of 2169 Patients
Abstract
BACKGROUND: The management of Wolff-Parkinson-White is based on the distinction between asymptomatic and symptomatic presentations, but evidence is limited in the asymptomatic population. METHODS AND RESULTS: The Wolff-Parkinson-White registry was an 8-year prospective study of either symptomatic or asymptomatic Wolff-Parkinson-White patients referred to our Arrhythmology Department for evaluation or ablation. Inclusion criteria were a baseline electrophysiological testing with or without radiofrequency catheter ablation (RFA). Primary end points were the percentage of patients who experienced ventricular fibrillation (VF) or potentially malignant arrhythmias and risk factors. Among 2169 enrolled patients, 1001 (550 asymptomatic) did not undergo RFA (no-RFA group) and 1168 (206 asymptomatic) underwent ablation (RFA group). There were no differences in clinical and electrophysiological characteristics between the 2 groups except for symptoms. In the no-RFA group, VF occurred in 1.5% of patients, virtually exclusively (13 of 15) in children (median age, 11 years), and was associated with a short accessory pathway antegrade refractory period (P<0.001) and atrioventricular reentrant tachycardia initiating atrial fibrillation (P<0.001) but not symptoms. In the RFA group, ablation was successful in 98.5%, and after RFA, no patients developed malignant arrhythmias or VF over the 8-year follow-up. Untreated patients were more likely to experience malignant arrhythmias and VF (log-rank P<0.001). Time-dependent receiver-operating characteristic curves for predicting VF identified an optimal anterograde effective refractory period of the accessory pathway cutoff of 240 milliseconds. CONCLUSIONS: The prognosis of the Wolff-Parkinson-White syndrome essentially depends on intrinsic electrophysiological properties of AP rather than on symptoms. RFA performed during the same procedure after electrophysiological testing is of benefit in improving the long-term outcomes.
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In an 8-year prospective study on 2169 symptomatic or asymptomatic WPW patients, those who developed VF showed more inducible pre-excited sustained AF triggered by AVRT (73.3% vs 44.9%) and shorter median accessory pathway ERP (220 vs 240 ms) than subjects without ventricular arrhythmias.
“In an 8-year prospective study on 2169 symptomatic or asymptomatic WPW patients, electrophysiologic testing revealed that patients who developed VF, showed more inducible pre-excited sustained AF triggered by AV reciprocating tachycardia (73.3% vs. 44.9%),and shorter median accessory pathway ERP (220 vs. 240 ms) than subjects not experiencing ventricular arrhythmias.322”
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 [322]
In that registry, benign arrhythmias including AVRT and AF developed in 15.6%, while 21.6% of older patients (median age 42 years) lost ventricular preexcitation and remained asymptomatic.
“Benign arrhythmias including AVRT and AF developed in 15.6%, while 21.6% of older patients (median age, 42 years) lost ventricular preexcitation remaining asymptomatic.322”
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 [322]
Radiofrequency catheter ablation has become firmly established as first-line therapy for paroxysmal supraventricular tachycardia over the past decade.
“In the past decade, radiofrequency catheter ablation has become firmly established as first-line therapy of paroxysmal SVT.320 -322”
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 [322]
Kaplan-Meier estimates showed that initially asymptomatic individuals were more likely to experience VF than symptomatic individuals.
“Of note, the Kaplan -Meier estimates showed that initially asymptomatic individuals were more likely to experience VF than the symptomatic individuals.322”
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 [322]
Several randomized and observational studies indicate that risk stratification using invasive electrophysiological testing may be beneficial in the asymptomatic WPW population.
“Several randomized and observational studies indicate that in the asymptomatic WPW population risk stratification using an invasive electrophysiological testing may be beneficial (Table 17).322,336,337,339,341,343”
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 [322]
Multivariable analysis showed that only shorter accessory pathway ERP and AVRT triggering AF were associated with VF or malignant arrhythmias.
“Multivariable analysis showed that only shorter accessory pathway ERP and AVRT triggering AF were associated with VF or malignant arrhythmias.322”
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 [322]
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References 33 · Cited by 212
- Authors
- Pappone, C., Vicedomini, G., Manguso, F., Saviano, M., Baldi, M., Pappone, A., Ciaccio, C., Giannelli, L., Ionescu, B., Petretta, A., Vitale, R., Cuko, A., Calovic, Z., Fundaliotis, A., Moscatiello, M., Tavazzi, L., & Santinelli, V.
- Affiliations
- Università degli Studi del Piemonte Orientale “Amedeo Avogadro” (IT)
- From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.).
- ORCID
- Venue
- Circulation
- Published
- 2014-09-02
- Volume
- 130
- Issue
- 10
- Pages
- 811-819
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2081702523
- Cited by
- 212
- References
- 33
- Citations by year
- 2026: 14 · 2025: 19 · 2024: 12 · 2023: 20 · 2022: 15 · 2021: 19 · 2020: 17 · 2019: 17 · 2018: 13 · 2017: 17 · 2016: 17 · 2015: 29 · 2014: 3
- FWCI
- 15.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- 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, radiofrequency catheter ablation, asymptomatic patients, ventricular fibrillation, accessory pathway refractory period, atrioventricular reentrant tachycardia, atrial fibrillation, malignant arrhythmias, long-term prognosis, risk stratification, electrophysiological study
- MeSH terms
- Adolescent, Adult, Arrhythmias, Cardiac, Child, Female, Follow-Up Studies, Humans, Male, Prospective Studies, Registries, Retrospective Studies, Risk Factors, Ventricular Fibrillation, Wolff-Parkinson-White Syndrome, Survival Rate, Treatment Outcome, Catheter Ablation, Young Adult, Accessory Atrioventricular Bundle
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