The Risk of Sudden Death in Wolff-Parkinson-White Syndrome: How High is the Risk?
In 1930, Dr. Louis Wolff, Sir John Parkinson and Paul Dudley White described a case series of 11 patients with a syndrome that now bears their name1. The first patient with a short PR interval, ventricular pre-excitation and supraventricular tachycardia (SVT) was described by Cohn and Fraser in 19131. Wood et al postulated the accessory pathway (AP) as its anatomical substrate in 1942 and a large population series reported the prevalence of pre-excitation to be 0.15% in 19622. Reports in 1971 and 1979 described sudden cardiac death (SCD) in WPW patients related to atrial fibrillation (AF) conducting rapidly over the AP with a short refractory period that deteriorated into ventricular fibrillation (VF)3,4. The first operative ablation of an AP was performed by Sealy in 19671 while Weber and Schmitz described the first endocardial catheter ablation of an AP in 19831. The evolution of curative catheter ablation has clearly become the treatment of choice in the patient with substantive symptoms. A continuing controversy has been the utilization of this therapy in the asymptomatic or less symptomatic individual and the central looming theme is the incidence of SCD as part of the natural history of this entity and our ability to predict it. The incidence of SCD in symptomatic patients with WPW syndrome was initially reported in the late 1960's and is estimated to be in the range of 0.25% per year or 3-4% over a lifetime5. (SELECT FULL TEXT TO CONTINUE)
- Received December 23, 2011.
- Accepted December 28, 2011.
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