Management of asymptomatic Wolff-Parkinson-White syndrome

Heart

Volumn 95, Issue 19, 2009, Pages 1628-1634

  Triedman, John K ^a  

^a BOSTON CHILDREN S HOSPITAL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CENTRAL STIMULANT AGENT; PSYCHOTROPIC AGENT;

AGE DISTRIBUTION; ATRIOVENTRICULAR BLOCK; CATHETER ABLATION; DISEASE ASSOCIATION; DRUG USE; ECG ABNORMALITY; ELECTROCARDIOGRAPHY MONITORING; HEART ARREST; HEART ATRIUM FIBRILLATION; HEART PALPITATION; HUMAN; INCIDENCE; MORTALITY; NERVE CONDUCTION; PHYSICAL ACTIVITY; PREVALENCE; PRIORITY JOURNAL; RADIOFREQUENCY ABLATION; REVIEW; RISK ASSESSMENT; RISK FACTOR; SIDE EFFECT; STROKE; SUDDEN DEATH; SUPRAVENTRICULAR TACHYCARDIA; THROMBOEMBOLISM; TREATMENT OUTCOME; WOLFF PARKINSON WHITE SYNDROME;

CATHETER ABLATION; COST-BENEFIT ANALYSIS; DEATH, SUDDEN, CARDIAC; ELECTROCARDIOGRAPHY; HUMANS; RISK ASSESSMENT; WOLFF-PARKINSON-WHITE SYNDROME;

EID: 70349462784     PISSN: 13556037     EISSN: 1468201X     Source Type: Journal    
DOI: 10.1136/hrt.2008.151175     Document Type: Review

References (26)

1. Chiale PA, Albino E, Garro HA, et al. Supernormal conduction in the anomalous bundles of the Wolff-Parkinson-White syndrome: an overlooked electrophysiologic property with potential clinical implications. J Cardiovasc Pharmacol Therap 2007;12:181-191 (Pubitemid 47305432)
2. Dreifus LS, Haiat R, Watanabe Y, et al. Ventricular fibrillation. A possible mechanism of sudden death in patients and Wolff-Parkinson-White syndrome. Circulation 1971;43:520-527 The relationship between pre-excitation and occurrence of ventricular fibrillation is proposed.
3. Munger TM, Packer DL, Hammill SC, et al. A population study of the natural history of Wolff-Parkinson-White syndrome in Olmsted County, Minnesota, 1953-1989. Circulation 1993;87:866-873
4. Fitzsimmons PJ, McWhirter PD, Peterson DW, et al. The natural history of Wolff-Parkinson-White syndrome in 228 military aviators: a long-term follow-up of 22 years. Am Heart J 2001;142:530-536 A long term follow-up study of a large series of healthy young adults with WPW, most asymptomatic, suggested a very low rate of sudden cardiac death-0.02%/year.
5. Pietersen AH, Andersen ED, Sandoe E. Atrial fibrillation in the Wolff-Parkinson-White syndrome. Am J Cardiol 1992;70:38A-43A.
6. Goudevenos JA, Katsouras CS, Graekas G, et al. Ventricular pre-excitation in the general population: a study on the mode of presentation and clinical course. Heart 2000;83:29-34. (Pubitemid 30307635)
7. Pappone C, Santinelli V, Rosanio S, et al. 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 This and subsequent papers from this group propose novel markers for sudden death risk in WPW patients (inducibility of SVT) and aggressive therapeutic approach to asymptomatic patients. Controversially, the rate of cardiac arrest in these untreated patients is remarkably higher than that previously estimated by other investigators. (Pubitemid 36092192)
8. Driscoll DJ, Edwards WD. Sudden unexpected death in children and adolescents. J Am Coll Cardiol 1985;5:118B-21B.
9. Basso C, Corrado D, Rossi L, et al. Ventricular preexcitation in children and young adults: atrial myocarditis as a possible trigger of sudden death. Circulation 2001;103:269-275 A pathological series finding that ventricular pre-excitation was present in 3-4% of young people experiencing sudden cardiac death, and that almost half had been asymptomatic before their terminal event. (Pubitemid 32095414)
10. Brembilla-Perrot B, Marcon O, Chometon F, et al. Supraventricular tachyarrhythmia as a cause of sudden cardiac arrest. J Interv Card Electrophysiol 2006;16:97-104. (Pubitemid 44924097)
11. Timmermans C, Smeets JL, Rodriguez LM, et al. Aborted sudden death in the Wolff-Parkinson-White syndrome. Am J Cardiol 1995;76:492-494
12. Klein GJ, Gulamhusein SS. Intermittent preexcitation in the Wolff-Parkinson-White syndrome. Am J Cardiol 1983;52:292-296
13. Milstein S, Sharma AD, Klein GJ. Electrophysiologic profile of asymptomatic Wolff-Parkinson-White pattern. Am J Cardiol 1986;57:1097-1100 (Pubitemid 16020909)
14. Bromberg BI, Lindsay BD, Cain ME, et al. Impact of clinical history and electrophysiologic characterization of accessory pathways on management strategies to reduce sudden death among children with Wolff-Parkinson-White syndrome. J Am Coll Cardiol 1996;27:690-695 Retrospective study of symptomatic patients with WPW identifying the association of severe symptoms with short pre-excited RR intervals, and allowing for an estimation of incremental risk of sudden death in such patients.
15. Dubin AM, Collins KK, Chiesa N, et al. Use of electrophysiologic testing to assess risk in children with Wolff-Parkinson-White syndrome. Cardiol in the Young 2002;12:248-252 Paediatric study including asymptomatic patients, which showed lack of association of symptomatic presentation with known risk factors for sudden death, implying that lack of symptoms is not predictive of low risk. (Pubitemid 41238838)
16. Gaita F, Giustetto C, Riccardi R, et al. Stress and pharmacologic tests as methods to identify patients with Wolff-Parkinson-White syndrome at risk of sudden death. Am J Cardiol 1989;64:487-490 A comparison of exercise stress testing and intracardiac EPS for risk stratification of WPW demonstrated that exercise testing has relatively low positive predictive value for identification of patients with short pre-excited RR intervals. (Pubitemid 19214578)
17. Bershader RS, Berul CI, Cecchin F, et al. Exercise testing for risk assessment in pediatric Wolff-Parkinson-White syndrome. Heart Rhythm 2007;4:S138-9.
18. Brembilla-Perrot B, Chometon F, Groben L, et al. Interest of non-invasive and semi-invasive testings in asymptomatic children with pre-excitation syndrome. Europace 2007;9:837-843 (Pubitemid 47371664)
19. Favale S, Minafra F, Massari V, et al. Transesophageal versus intracardiac atrial stimulation in assessing anterograde conduction properties of the accessory pathway in Wolff-Parkinson-White syndrome. Intl J Cardiol 1991;30:209-214
20. Harahsheh A, Du W, Singh H, et al. Risk factors for atrioventricular tachycardia degenerating to atrial flutter/fibrillation in the young with Wolff-Parkinson-White. Pacing Clin Electrophysiol 2008;31:1307-1312
21. Antz M, Weiss C, Volkmer M, et al. Risk of sudden death after successful accessory atrioventricular pathway ablation in resuscitated patients with Wolff-Parkinson-White syndrome. J Cardiovasc Electrophysiol 2002;13:231-236 Successful therapeutic ablation appears to eliminate the risk of sudden cardiac death. This study, like many others, suffers from a small number of patient-years follow-up, relative to the incidence of sudden death in WPW. (Pubitemid 34259204)
22. Hamada T, Hiraki T, Ikeda H, et al. Mechanisms for atrial fibrillation in patients with Wolff-Parkinson-White syndrome. J Cardiovasc Electrophysiol 2002;13:223-229 (Pubitemid 34259202)
23. Kugler JD, Danford DA, Houston KA, et al. Pediatric radiofrequency catheter ablation registry success, fluoroscopy time, and complication rate for supraventricular tachycardia: comparison of early and recent eras. J Cardiovasc Electrophysiol 2002;13:336-341 These results of a large, multicentre registry of accessory pathway ablation provide basic data on rates and risk factors associated with catheter therapies, necessary for risk-benefit analysis.
24. Van Hare GF, Colan SD, Javitz H, et al. Prospective assessment after pediatric cardiac ablation: fate of intracardiac structure and function, as assessed by serial echocardiography. Am Heart J 2007;153:815-20, 820.e1-6 (Pubitemid 46602141)
25. Friedman RA, Walsh EP, Silka MJ, et al. NASPE Expert Consensus Conference: radiofrequency catheter ablation in children with and without congenital heart disease. Report of the writing committee. North American Society of Pacing and Electrophysiology. Pacing Clin Electrophysiol 2002;25:1000-1017 Findings of a consensus conference indicate that the diagnosis of asymptomatic WPW is considered to be a class 2b/class 3 indication for catheter ablation. This indicates that it is at clinical equipoise, with expert clinicians holding divergent opinions.
26. Zipes DP, Ackerman MJ, Estes NA 3rd, et al. Task Force 7: arrhythmias. J Am Coll Cardiol 2005;45:1354-63. The authoritative recommendation of an expert panel is that patients with untreated WPW should not participate in highly competitive sports, unless they can be demonstrated to be in a "low risk" category for sudden cardiac death by intracardiac or non-invasive EPS.