Multiple accessory pathways in the Wolff-Parkinson-White syndrome as a risk factor for ventricular fibrillation

Abstract

Ventricular fibrillation (VF) after atrial fibrillation is the mechanism of sudden death in most patients with Wolff-Parkinson-White (WPW) syndrome. 1–3 Initial data from Duke University 1 suggested that patients who had VF had a shortest RR interval between preexcited beats during atrial fibrillation <250 ms. The use of the shortest RR interval during atrial fibrillation in predicting sudden death prospectively is, however, limited by its low positive predictive value. 4 Several studies 1,5 have also noted the increased frequency of multiple accessory pathways in VF patients with WPW syndrome although other investigators 6 suggested that this was not the case. We sought to determine whether VF occurs more frequently in patients with multiple accessory pathways and whether multiple pathways may be considered as an additional risk factor for this complication.