Advertisement

Comparison of Outcomes of Catheter Ablation in Asymptomatic Versus Symptomatic Preexcitation to Guidelines and Beyond

      Management of asymptomatic subjects with preexcitation remains controversial. Our objective was to analyze the reasons an electrophysiological study (EPS) was performed in an asymptomatic population referred for the procedure, and compare the results of catheter ablation between asymptomatic and symptomatic patients. Patients ≥18 years of age with preexcitation referred for an EPS and ablation were grouped as either symptomatic or asymptomatic. We analyzed in both subsets for (1) reasons for the procedure, (2) EPS results (anterograde effective refractory period of the accessory pathway, tachycardia/atrial fibrillation inducibility, anatomical localization), (3) success of the procedure, and (4) incidence of complications. We included 175 patients, 121 of which were symptomatic (39 ± 16 years) and 54 were asymptomatic (35 ± 14 years, p = NS not significant). The most frequent symptoms were palpitations (87%) and syncope (7%). EPS was performed in 44 of 54 asymptomatic patients mainly because of involvement in sports (60%) or high-risk employment (14%). Anterograde effective refractory period was significantly longer in asymptomatic patients (314 ± 55 milliseconds) than in symptomatic patients (278 ± 46 milliseconds; p <0.001). Orthodromic tachycardia inducibility was significantly higher in symptomatic than in asymptomatic patients (69% and 27%, respectively; p <0.001). A total of 170 accessory pathways (49% left free wall, 12% right free wall, 39% septal) were observed without significant differences in the anatomical location between groups. Catheter ablation was attempted in all patients, succeeding in 98% of symptomatic and 95% of asymptomatic patients, without major complications in either group. In conclusion, the reasons for invasive evaluation of asymptomatic patients with preexcitation may be outside the scope of current guidelines. Catheter ablation produces excellent results without major complications.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Brugada J
        • Katritsis DG
        • Arbelo E
        • Arribas F
        • Bax JJ
        • Blomström-Lundqvist C
        • Calkins H
        • Corrado D
        • Deftereos SG
        • Diller GP
        • Gomez-Doblas JJ
        • Gorenek B
        • Grace A
        • Ho SY
        • Kaski JC
        • Kuck KH
        • Lambiase PD
        • Sacher F
        • Sarquella-Brugada G
        • Suwalski P
        • Zaza A
        ESC Scientific Document Group. 2019 ESC guidelines for the management of patients with supraventricular tachycardia. The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology.
        Eur Heart J. 2020; 41: 655-720
        • Page RL
        • Joglar JA
        • Caldwell MA
        • Calkins H
        • Conti JB
        • Deal BJ
        • Estes III, NA
        • Field ME
        • Goldberger ZD
        • Hammill SC
        • Indik JH
        • Lindsay BD
        • Olshansky B
        • Russo AM
        • Shen WK
        • Tracy CM
        • Al-Khatib SM
        2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
        Heart Rhythm. 2016; 13: e136-e221
        • Al-Khatib SM
        • Arshad A
        • Balk EM
        • Das SR
        • Hsu JC
        • Joglar JA
        • Page RL.
        Risk stratification for arrhythmic events in patients With asymptomatic pre-excitation: a systematic review for the 2015 ACC/AHA/HRS guideline for the management of adult patients With supraventricular tachycardia: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice guidelines and the Heart Rhythm Society.
        J Am Coll Cardiol. 2016; 67: 1624-1638
        • Brembilla-Perrot B
        • Girerd N
        • Sellal JM.
        Unresolved questions associated with the management of ventricular preexcitation syndrome.
        Pacing Clin Electrophysiol. 2018; 41: 839-844
        • Klein GJ
        • Yee R
        • Sharma AD.
        Longitudinal electrophysiologic assessment of asymptomatic patients with the Wolff-Parkinson-White electrocardiographic pattern.
        N Engl J Med. 1989; 320: 1229-1233
        • Obeyesekere MN
        • Leong-Sit P
        • Massel D
        • Manlucu J
        • Modi S
        • Krahn AD
        • Skanes AC
        • Yee R
        • Gula LJ
        • Klein GJ.
        Risk of arrhythmia and sudden death in patients with asymptomatic preexcitation: a meta-analysis.
        Circulation. 2012; 125: 2308-2315
        • Di Mambro C
        • Russo MS
        • Righi D
        • Placidi S
        • Palmieri R
        • Silvetti MS
        • Gimigliano F
        • Prosperi M
        • Drago F.
        Ventricular pre-excitation: symptomatic and asymptomatic children have the same potential risk of sudden cardiac death.
        Europace. 2015; 17: 617-621
        • Pappone C
        • Santinelli V
        • Rosanio S
        • Vicedomini G
        • Nardi S
        • Pappone A
        • Tortoriello V
        • Manguso F
        • Mazzone P
        • Gulletta S
        • Oreto G
        • Alfieri O.
        Usefulness of invasive electrophysiologic testing to stratify the risk of arrhythmic events in asymptomatic patients with Wolff-Parkinson-White pattern: results from a large prospective long-term follow-up study.
        J Am Coll Cardiol. 2003; 41: 239-244
        • Książczyk TM
        • Pietrzak R
        • Werner B.
        Management of young athletes with asymptomatic preexcitation-A review of the literature.
        Diagnostics (Basel). 2020; 10: 824
        • Regitz-Zagrosek V
        • Blomstrom Lundqvist C
        • Borghi C
        • Cifkova R
        • Ferreira R
        • Foidart JM
        • Gibbs JS
        • Gohlke-Baerwolf C
        • Gorenek B
        • Iung B
        • Kirby M
        • Maas AH
        • Morais J
        • Nihoyannopoulos P
        • Pieper PG
        • Presbitero P
        • Roos-Hesselink JW
        • Schaufelberger M
        • Seeland U
        • Torracca L
        • European Society of Gynecology (ESG), Association for European Paediatric Cardiology (AEPC), German Society for Gender Medicine (DGesGM)
        • ESC Committee for Practice Guidelines
        ESC guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC).
        Eur Heart J. 2011; 32: 3147-3197
        • Kounis NG
        • Zavras GM
        • Papadaki PJ
        • Soufras GD
        • Kitrou MP
        • Poulos EA.
        Pregnancy-induced increase of supraventricular arrhythmias in Wolff-Parkinson-White syndrome.
        Clin Cardiol. 1995; 18: 137-140
        • Widerhorn J
        • Widerhorn AL
        • Rahimtoola SH
        • Elkayam U.
        WPW syndrome during pregnancy: increased incidence of supraventricular arrhythmias.
        Am Heart J. 1992; 123: 796-798
        • Bengali R
        • Wellens HJ
        • Jiang Y.
        Perioperative management of the Wolff-Parkinson-White syndrome.
        J Cardiothorac Vasc Anesth. 2014; 28: 1375-1386
        • Fleisher LA
        • Fleischmann KE
        • Auerbach AD
        • Barnason SA
        • Beckman JA
        • Bozkurt B
        • Davila-Roman VG
        • Gerhard-Herman MD
        • Holly TA
        • Kane GC
        • Marine JE
        • Nelson MT
        • Spencer CC
        • Thompson A
        • Ting HH
        • Uretsky BF
        • Wijeysundera DN
        • American College of Cardiology, American Heart Association
        2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines.
        J Am Coll Cardiol. 2014; 64: e77-e137
        • Santinelli V
        • Radinovic A
        • Manguso F
        • Vicedomini G
        • Ciconte G
        • Gulletta S
        • Paglino G
        • Sacchi S
        • Sala S
        • Ciaccio C
        • Pappone C.
        Asymptomatic ventricular preexcitation: a long-term prospective follow-up study of 293 adult patients.
        Circ Arrhythm Electrophysiol. 2009; 2: 102-107
        • Svendsen JH
        • Dagres N
        • Dobreanu D
        • Bongiorni MG
        • Marinskis G
        • Blomström-Lundqvist C
        Scientific Initiatives Committee, European Heart Rhythm Association. Current strategy for treatment of patients with Wolff-Parkinson-White syndrome and asymptomatic preexcitation in Europe: European Heart Rhythm Association survey.
        Europace. 2013; 15: 750-753
        • Chevalier P
        • Cadi F
        • Scridon A
        • Girerd N
        • Bejan-Angoulvan T
        • Morel E
        • Hot IJ
        • Di Filippo S
        • Ganne C
        • Colin C.
        Prophylactic radiofrequency ablation in asymptomatic patients with Wolff-Parkinson-White is not yet a good strategy: a decision analysis.
        Circ Arrhythm Electrophysiol. 2013; 6: 185-190
        • Pappone C
        • Santinelli V
        • Manguso F
        • Augello G
        • Santinelli O
        • Vicedomini G
        • Gulletta S
        • Mazzone P
        • Tortoriello V
        • Pappone A
        • Dicandia C
        • Rosanio S.
        A randomized study of prophylactic catheter ablation in asymptomatic patients with the Wolff-Parkinson-White syndrome.
        N Engl J Med. 2003; 349: 1803-1811
        • Obeyesekere MN
        • Klein GJ.
        Application of the 2015 ACC/AHA/HRS guidelines for risk stratification for sudden death in adult patients with asymptomatic pre-excitation.
        J Cardiovasc Electrophysiol. 2017; 28: 841-848