Risk of Arrhythmia and Sudden Death in Patients with Asymptomatic Pre-Excitation: A Meta Analysis
Background—The incidence of sudden cardiac death (SCD) and the management of this risk in patients with asymptomatic pre-excitation remains controversial. The purpose of this meta-analysis was to define the incidence of SCD and supraventricular tachycardia (SVT) in patients with asymptomatic Wolff-Parkinson-White ECG pattern.
Methods and Results—We performed a systematic search of prospective, retrospective, randomized or cohort, English-language studies in EMBASE and Medline through to February 2011. Studies reporting on asymptomatic patients with pre-excitation who did not undergo ablation were included. Twenty studies involving 1,869 patients met our inclusion criteria. Participants were primarily male with mean age ranging from 7 to 43 years. Ten SCDs were reported involving 11,722 person-years (PYrs) of follow-up. Seven studies originated from Italy and reported 9 SCDs. The risk of SCD is estimated at 1.25 per 1,000 PYrs (95% Confidence Interval (CI): 0.57 to 2.19). 156 SVT's were reported involving 9,884 PYrs from 18 studies. The risk of SVT was 16 (95% CI: 10 to 24) events per 1,000 PYrs of follow-up. Children had numerically higher SCD (1.93 (95% CI: 0.57 to 4.1) vs. 0.86 (95% CI: 0.28 to 1.75), p=0.07) and SVT event rates (20 (95% CI: 12 to 31) vs. 14 (95% CI: 6 to 25), p=0.38) compared to adults.
Conclusions—The low incidence of SCD and low risk of SVT argues against routine invasive management in most asymptomatic patients with the Wolff-Parkinson-White ECG pattern.
- Received July 11, 2011.
- Accepted March 9, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited