180 Is it a risk of stroke in Wolff Parkinson White syndrome?

Abstract

Atrial fibrillation (AF) is a major cause of stroke. AF incidence is increased in Wolff-Parkinson-White syndrome (WPW), represents about 10% of spontaneous arrhythmias and has several mechanisms as the degeneration of atrioventricular reentrant tachycardia (AVRT) into AF, the AF facilitation by the atrial insertion of accessory pathway (AP) or another origin. The purpose of study was to assess the incidence of stroke in patients (pts) who had a preexcitation syndrome. 707 pts aged from 5 to 85 years (mean 34.5 ± 17) were studied for a WPW: 93 pts had unexplained syncope; 247 pts were asymptomatic; 367 pts had spontaneous tachycardias; among these pts 52 had documented AF. Electrophysiological study (EPS) consisted of atrial pacing and programmed atrial stimulation in control state and if necessary after infusion of isoproterenol. Clinical and electrophysiological data were collected. Stroke was noted in 5 pts (0.7%), 2 women, 3 men aged from 53 to 75 years. They had a normal carotid and transcranial Doppler ultrasonography. One pt had ischemic heart disease and the remaining pts had no heart disease. Their age was significantly older than remaining population (62 ± 9 years vs 34 ± 17) (p<0.0002). Only one pt had spontaneous AF; 51 other pts with spontaneous AF had no stroke. One of 247 was asymptomatic; one pt of 93 had syncope and 2 pts of 315 had spontaneous AVRT. At EPS, one asymptomatic pt had AP with long refractory period and no inducible tachycardia. Two pts with spontaneous tachycardias had only inducible AVRT and the pt with spontaneous AF had inducible antidromic tachycardia and AF. The pt with syncope had only inducible AF. These electrophysiological data did not differ from the remaining population. Anticoagulants were maintained after AP ablation, although the disappearance of arrhythymias. The risk of stroke in WPW syndrome is very low (0.7%). Only one clinical factor differs significantly from remaining population, the relatively old age (mean 62 ± 9 years). All other clinical factors as sex, associated heart disease, spontaneous symptoms and all electrophysiological data did not differ from remaining population.