Abstract 12516: Changes of Electrophysiological Data Through the Life in the Preexcitation Syndrome
Background: The number of accessory pathway (AP) ablations has dramatically increased and the natural follow-up of Wolff-Parkinson White syndrome (WPW) becomes not possible. Changes of electrophysiological data were reported. The purpose of the study was to report the clinical and electrophysiological data of patients with a WPW, studied within 1 to 20 years of one another to evaluate the changes of the data.
Methods: 2 baseline EPS were performed within 1 to 20 years of one another (mean 9 y ± 4) in 62 patients, 37 males and 25 females, aged initially from 10 to 67 y (31±15), with a patent WPW. First electrophysiological study (EPS) was indicated for syncope (n=7), atrioventricular reentrant tachycardias (AVRT) (n=34), atrial fibrillation (AF) (n=5) or for asymptomatic preexcitation (n= 16). The protocol was similar: the higher rate conducted through AP was measured and programmed atrial stimulation with 1 and 2 ES performed in control state (CS) and after isoproterenol.
Results: At 2nd study, among patients studied for syncope at study 1, 2 have still syncope, 2 have AVRT, 1 has rapid AF, and 2 are asymptomatic. Among patients with AVRT at study 1, 25 have AVRT, 7 are asymptomatic and 2 have AF. Among patients with AF, 4 have still AF and 1 is asymptomatic. Among asymptomatic patients, 3 have a spontaneous malignant form, 7 remain asymptomatic, 3 have AVRT, 1 has syncope and 1 has AF. All AVRT's or AF's occurred in patients with inducible AVRT or AF at EPS 1. The higher rate conducted by AP was significantly lower in CS and after isoproterenol at EPS 2 (157±95 b/min, 193±113) than at EPS 1 (199±65, 257±65). AP has lost anterograde conduction properties in 18 patients aged from 17 to 67 years (47±15); 16 of them had initially 1/1 conduction through AP ≤ 170/min; however 8 had still AVRT. Among 24 patients with initially rapid conduction through AP (≥ 240/min), 17 have a rapid conduction at EPS 2; 3 of them, which were asymptomatic developed rapid AF, but 2 became asymptomatic with a benign form.
Conclusions: The study confirms that a benign form of WPW without inducible AVRT or AF remains benign and that AP ablation is not indicated. Patients with AVRT and AP with a long refractory period become asymptomatic in 20 % of cases. Patients with inducible rapid AF have still a malignant form in 71 % of cases.
- © 2010 by American Heart Association, Inc.