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(Circulation. 2005;112:2201-2216.)
© 2005 American Heart Association, Inc.

Controversies in Cardiovascular Medicine

Should catheter ablation be performed in asymptomatic patients with Wolff-Parkinson-White syndrome?

When to Perform Catheter Ablation in Asymptomatic Patients With a Wolff-Parkinson-White Electrocardiogram

Hein J. Wellens, MD

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
What to do when a person without any cardiac complaint shows a Wolff-Parkinson-White (WPW) pattern on the ECG has been an important question for more than 2 decades. Recent articles by Pappone et al^1–3 make it necessary to revisit that question.

	Background

 
Epidemiological data indicate that 0.1% to 0.3% of the general population have ECG findings suggesting that during sinus rhythm, in addition to AV conduction over the AV node His pathway, there is also AV conduction over an accessory AV pathway (AP).⁴ This means that each year 4 new cases are found in a population of 100 000. It is also known that there is a 4-fold increase of this finding in family members of WPW patients.⁵

The WPW patient is often symptomatic because of cardiac arrhythmias. When arrhythmias are present, the disorder is called the WPW syndrome. The 2 most common types of arrhythmia in the WPW syndrome are (1) a circus movement tachycardia (CMT), also called an AV reentrant tachycardia, in which AV conduction goes by way of the normal AV conduction system and VA conduction over the AP and (2) atrial fibrillation (AF).⁶

AF can be a life-threatening arrhythmia in the WPW syndrome if the AV AP has a short anterograde refractory period (RP), allowing many atrial impulses to be conducted to the ventricle. That will result in very high ventricular rates with possible deterioration into ventricular fibrillation (VF) and sudden death.^7,8

A CMT that in general is well tolerated by the patient when additional heart disease . . . [Full Text of this Article]

Carlo Pappone, MD, PhD; Vincenzo Santinelli, MD

Hein J. Wellens, MD

Carlo Pappone, MD, PhD; Vincenzo Santinelli, MD

Correspondence to Hein J. Wellens, MD, Cardiovascular Research Institute Maastricht, 21 Henric van Veldekeplein, 6211 TG Maastricht, the Netherlands (e-mail hwellens@xs4all.nl); and to Carlo Pappone, MD, or Vincenzo Santinelli, MD, Department of Cardiology, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy (e-mail carlo.pappone@hsr.it or vincenzo.santinelli@hsr.it). Correspondence to Carlo Pappone, MD, or Vincenzo Santinelli, MD, Department of Cardiology, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy. E-mail carlo.pappone@hsr.it or vincenzo.santinelli@hsr.it

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