The Asymptomatic Wolff-Parkinson-White Patient: Time to be More Proactive?
It is well known by now that sudden cardiac death (SCD) may occur even in the asymptomatic individual with Wolff-Parkinson-White (WPW) pattern1. This is related to the occurrence of atrial fibrillation (AF) with a rapid ventricular response leading to ventricular fibrillation (VF). The essential and critical risk factor is the presence of an accessory pathway(s) (AP) with critically short antegrade refractoriness. The most common numeric in the literature reflecting this is shortest RR interval between pre-excited cycles <250 ms (SPRRI) in AF. The risk of SCD in the individual with asymptomatic WPW has been estimated to be low, in the range of 0.05-0.2% per year1, a risk that can obviously be eliminated with successful, uncomplicated catheter ablation. These facts are not in dispute. The controversy that remains is related simply to the fact that population wide electrophysiological assessment and ablation cannot be carried out without risk of complications and even mortality that can mitigate the benefit and broad screening and electrophysiologically based management would be very costly2. Current guidelines reflect this3 by suggesting that electrophysiological assessment with a view to ablation is reasonable when a well-informed patient chooses the small risk of ablation over a small risk due to the natural history (2A recommendation) depending on their individual circumstances. Further, there is little advocacy in the guidelines for large-scale population screening. Do we now have evidence to support improved clinical outcomes for electrophysiological assessment with a view to ablation in all individuals with the WPW pattern in the general population?
- Atrio-Ventricular Re-entrant Tachycardia
- Accessory Pathway
- Supra-Ventricular Tachycardia
- Wolff-Parkinson-White syndrome
- ventricular fibrillation
- atrial fibrillation
- sudden cardiac death
- Received July 3, 2014.
- Accepted July 14, 2014.