Stress and pharmacologic tests as methods to identify patients with Wolff-Parkinson-White syndrome at risk of sudden death.
Noninvasive stress and pharmacologic tests with procainamide and propafenone were studied as methods to identify patients with Wolff-Parkinson-White syndrome (WPW) who would otherwise be judged at risk of sudden death on the basis of electrophysiologic criteria: the shortest RR interval during induced atrial fibrillation less than or equal to 250 ms or accessory pathway anterograde effective refractory period less than or equal to 250 ms. Sixty-five patients were studied. Twenty-four patients fulfilled the electrophysiologic risk criteria (group A) and 41 patients fulfilled none of these criteria (group B). Persistence of preexcitation during stress test showed a sensitivity of 96% and a specificity of 17% to identify group A patients; its positive predictive value was 40% and negative predictive value 88%. With both procainamide and propafenone tests persistence of preexcitation identified group A patients with a sensitivity of 96% and a specificity of 51%; their positive and negative predictive value were, respectively, 53 and 95%. Stress and pharmacologic tests have good sensitivity and negative predictive value, but low specificity and positive predictive value.
Istituto di Medicina e Chirurgia Cardiovascolare, Università di Torino, Italy.
F
F
Gaita
C
C
Giustetto
R
R
Riccardi
L
L
Mangiardi
A
A
Brusca
D000293:Adolescent; D000328:Adult; D002648:Child; D003645:Death, Sudden / Q000209:etiology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011342:Procainamide; D011405:Propafenone; D012307:Risk Factors; D014927:Wolff-Parkinson-White Syndrome / Q000150:complications* / Q000503:physiopathology
D011405:Propafenone; D011342:Procainamide