Risk of Malignant Arrhythmias in Initially Symptomatic Patients with WPW Syndrome: Results of a Prospective Long-Term Electrophysiological Follow-Up Study
Background—The available amount of detailed long-term data in patients with WPW syndrome is limited and no prospective electrophysiological studies looking at predictors of MA are available.
Methods and Results—Among 8575 symptomatic WPW patients with atrioventricular reentrant tachycardia (AVRT) referred for EPT, 369 (mean age, 23±12.5 years) declined catheter ablation and were followed. Primary endpoint of the study was to evaluate over a 5-year follow-up predictors and characteristics of patients developing MA. After a mean follow-up of 42.1±10 months, MA developed in 29 patients (mean age, 13.9±5.6 years, 26 M) resulting in presyncope/syncope (25 patients), hemodynamic collapse (3 patients) or cardiac arrest due to ventricular fibrillation (1 patient). Of the remaining 340 patients, 168 (mean age, 34.2±9.0 years) remained asymptomatic up to 5 years and 172 (mean age, 13.6±5.1) had benign recurrence including sustained AVRT (132 patients) or AF (40 patients). As compared with no-MA group, MA group showed shorter AP-AERP (p<0.001), more often exhibited multiple AP (p<0.001) and AVRT triggering sustained preexcited AF (AVRT-AF) was more frequently inducible (p<0.001). Multivariable analysis demonstrated that short AP-AERP (p<0.001) and AVRT-AF (p<0.001) were independent predictors of MA.
Conclusions—Symptomatic patients with WPW syndrome generally have a good outcome and predictors of malignant arrhythmias are similar to those reported for asymptomatic patients with ventricular preexcitation.
- Received September 1, 2011.
- Accepted December 5, 2011.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited