Clinical Electrophysiology -> SVT/AVNRT/WPW/AT: -> Epidemiology of Cardiac Arrhythmias/ Epidemiology D-PO04 - Poster Session IV (ID 15) Poster

D-PO04-236 - Treatment Of Patients With Asymptomatic Ventricular Pre-excitation. Results Of A Tiered Noninvasive Electrocardiographic And Invasive Electrophysiological Risk Stratification Approach (ID 509)


Background: Treatment of asymptomatic Wolff-Parkinson-White (aWPW) patients has been a contentious issue, with approaches ranging from mere follow up to ablation of all accessory pathways (APs).
Objective: To assess the ability of a tiered, mixed noninvasive and invasive risk stratification to detect high risk aWPW patients.
Methods: The first step of the proposed approach focused on detection of low-risk APs with intermittent pre-excitation (pre-excitation disappearance - PED - on 12-lead ECG, or on 24-hour Holter recording, or during an exercise stress test). In cases of no PED, invasive electrophysiological study (EPS) was pursued in order to determine the effective refractory period (ERP) of the AP, and, should it be found ≤250msec, endocardial ablation (EA) was offered.
Results: Eighty-four aWPW patients were studied over a 20-year period (55 male, mean age 29 years), in 32 of whom PED was noted (7 on ECG, 11 on 24-hour Holter, and 14 on exercise stress test). The remaining 52 patients were submitted to invasive EPS revealing at least one AP (23 were located at the left ventricular free wall, 23 at the posterior septal area, 2 were anteroseptal, and 5 were located at the right ventricular wall - a single patient had 2 APs - mean ERP was 302msec / range 180-360msec). An EA of the AP was offered to 9 high-risk (based on the above criteria) patients with one of them declining. All procedures were successful with pre-excitation disappearance. During a prolonged follow up period (mean duration 7.2 years) no sudden cardiac deaths were observed, with all patients remaining asymptomatic.
Conclusion: A tiered, mixed noninvasive electrocardiographic and invasive electrophysiological risk stratification approach leading to ablation of high-risk APs is safe and effective in aWPW patients.