EP News: Clinical

Abstract

Pappone et al (Circulation 2014;130:811–819, PMID 2505240) evaluated long-term outcomes of Wolff-Parkinson-White (WPW) patients referred for ablation. Electrophysiologic study (EPS) with or without radiofrequency catheter ablation (RFA) was necessary for inclusion. Among 2169 patients, 1001 (550 asymptomatic) did not undergo RFA (no-RFA group), and 1168 (206 asymptomatic) underwent ablation (RFA group). There were no differences between the 2 groups except for symptoms. In the no-RFA group, ventricular fibrillation (VF) occurred in 1.5%, with 13 of 15 occurring in children. VF was associated with a short accessory pathway anterograde refractory period (P <.001) and AV reentrant tachycardia initiating atrial fibrillation (P <.001) but not symptoms. In the RFA group, ablation was successful in 98.5%, and after RFA, no patients had VF over 8-year follow-up. Untreated patients were more likely to have VF (P <.001). An anterograde effective refractory period of the accessory pathway <240 ms predicted VF. The authors conclude that the prognosis of WPW syndrome depends on the properties of the pathway and not symptoms. RFA performed during the same procedure as EPS improves outcomes.