Abstract
Objective: The diagnosis of ventricular preexcitation syndromes is often occasional and with underestimated risk, showing controversies in its stratification and indication of prophylactic ablation. This work aims to explore and summarize the data in the literature, exposing the authors’ conclusions regarding this review. Methods: The authors prepared this work based on the latest guideline of the European Society of Cardiology plus a search for articles published in MEDLINE whose titles related to sudden death from ventricular fibrillation in patients with ventricular preexcitation. Discussion: Sudden death secondary to preexcited atrial fibrillation with degeneration to ventricular fibrillation is the most feared event in Wolff-Parkinson-White syndrome, has an average annual incidence of 0.15 to 0.39%, affecting individuals with structurally normal heart. The noninvasive stratification methods do not demonstrate adequate efficacy, and an electrophysiological study is recommended for all cases at the time of diagnosis. The most severe criteria for sudden death are shortest preexcited RR interval ≤ 250 ms (SPERRI or SPRRI); accessory pathway effective refractory period (APERP) ≤ 250 ms; presence of multiple accessory bundles; shortest paced cycle length with preexcitation during atrial pacing ≤ 250ms (SPPCL); Ebstein anomaly; induction of sustained supraventricular tachycardia. Conclusion: The low rate of complications during the diagnostic exam as well as in the therapeutic procedure, added to the high percentage of success of radiofrequency ablation, leads to indicate early the execution of electrophysiological study as a more diligent and accurate measure in the reduction of sudden death events in patients with ventricular preexcitation syndromes.
Highlights
With an annual incidence of between 0.15 and 0.39%, sudden death as the first clinical manifestation of WolffParkinson-White Syndrome (WPWS) is a rare but well-documented event[1,2].The event occurs in patients with acute atrial fibrillation with high ventricular response and anterograde conduction through an accessory bundle
The authors prepared this work based on the latest guideline of the European Society of Cardiology plus a search for articles published in MEDLINE, whose titles related to sudden death from ventricular fibrillation in patients with ventricular pre-excitation, highlighting the risk factors and stratification methods
Pick et al.[6,7,8] revealed that the arrhythmias exhibited by patients with WPWS were attributed to differences in electrical properties between an accessory pathway and the atrioventricular node
Summary
With an annual incidence of between 0.15 and 0.39%, sudden death as the first clinical manifestation of WolffParkinson-White Syndrome (WPWS) is a rare but well-documented event[1,2]. The event occurs in patients with acute atrial fibrillation with high ventricular response and anterograde conduction through an accessory bundle. Rapid ventricular stimulation leads to a deterioration of the rhythm and triggers ventricular fibrillation[2,3]. The diagnosis of ventricular pre-excitation syndromes is often occasional and of underestimated risks, presenting controversies in its stratification and therapeutic orientation, which may evolve with catastrophic outcomes[2,3]
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