Risk of malignant arrhythmias in initially symptomatic patients with Wolff-Parkinson-White syndrome: results of a prospective long-term electrophysiological follow-up study.
BACKGROUND
The available amount of detailed long-term data in patients with Wolff-Parkinson-White syndrome is limited, and no prospective electrophysiological studies looking at predictors of malignant arrhythmia are available.


RESULTS
Among 8575 symptomatic Wolff-Parkinson-White patients with atrioventricular reentrant tachycardia referred for electrophysiological test, 369 (mean age, 23±12.5 years) declined catheter ablation and were followed up. The primary end point of the study was to evaluate over a 5-year follow-up the predictors and characteristics of patients who develop malignant arrhythmias. After a mean follow-up of 42.1±10 months, malignant arrhythmias developed in 29 patients (mean age, 13.9±5.6 years; 26 male), resulting in presyncope/syncope (25 patients), hemodynamic collapse (3 patients), or cardiac arrest caused by 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 years) had benign recurrence, including sustained atrioventricular reentrant tachycardia (132 patients) or atrial fibrillation (40 patients). Compared with the group with no malignant arrhythmias, the group with malignant arrhythmias showed shorter accessory-pathway effective refractory period (P<0.001) and more often exhibited multiple accessory pathways (P<0.001), and atrioventricular reentrant tachycardia triggering sustained pre-excited atrial fibrillation was more frequently inducible (P<0.001). Multivariable analysis demonstrated that short accessory-pathway effective refractory period (P<0.001) and atrioventricular reentrant tachycardia triggering sustained pre-excited atrial fibrillation (P<0.001) were independent predictors of malignant arrhythmias.


CONCLUSIONS
Symptomatic patients with Wolff-Parkinson-White syndrome generally have a good outcome, and predictors of malignant arrhythmias are similar to those reported for asymptomatic patients with ventricular pre-excitation.
Department of Arrhythmology, Maria Cecilia Hospital, Via Corriera 1, Cotignola, Italy. cpappone@gvm-vmc.it
Carlo
C
Pappone
Gabriele
G
Vicedomini
Francesco
F
Manguso
Mario
M
Baldi
Alessia
A
Pappone
Andrea
A
Petretta
Raffaele
R
Vitale
Massimo
M
Saviano
Cristiano
C
Ciaccio
Luigi
L
Giannelli
Zarko
Z
Calovic
Luigi
L
Tavazzi
Vincenzo
V
Santinelli
D058606:Accessory Atrioventricular Bundle / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology; D002648:Child; D015331:Cohort Studies; D015897:Comorbidity; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012032:Refractory Period, Electrophysiological / Q000502:physiology; D012189:Retrospective Studies; D012307:Risk Factors; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000150:complications* / Q000453:epidemiology*; D014927:Wolff-Parkinson-White Syndrome / Q000150:complications* / Q000453:epidemiology*; D055815:Young Adult