Abstract 2874: Is it Time to Revisit Current Guidelines? A New Algorithm to Identify High-Risk Asymptomatic WPW Subjects for Prophylactic Ablation of Accessory Pathways
Background: Among the asymptomatic Wolff-Parkinson-White population, there are no data to select high-risk subjects for prophylactic catheter ablation.
Materials and Methods: We prospectively collected clinical, electrophysiologic and follow-up data among 477 initially asymptomatic subjects with Wolff-Parkinson-White syndrome between 1990 and 2004 (63.3% males; median age at diagnosis, 26 years). Subjects underwent invasive electrophysiologic testing and serial follow-up evaluation. The primary end-point was the occurrence of a first arrhythmic event during follow-up and risk factors were determined by a logistic regression model.
Results: During a median follow-up of 54 months (range, 7–168), 397 subjects (83.2%) remained asymptomatic (median age, 31 years) and 80 (16.7%) presented a first arrhythmic event (median age, 17 years), which was life-threatening in 26 subjects (5.4%; median age, 11.5 years); in particular, of the 26 subjects with life-threatening events five experienced a resuscitated cardiac arrest and 2 died suddenly. Age (p=0.033), tachyarrhythmia inducibility (p=0.002), the presence of multiple pathways (p=0.001), and the anterograde refractory period of accessory pathways (p=0.017) were all predictors of future arrhythmic events. By combining these four risk factors, we stratified patients into low, moderate, and high-risk groups.
Conclusions: We can now propose a new accurate algorithm to stratify asymptomatic WPW population raising the possibility of primary prevention by prophylactic catheter ablation in high-risk subjects.