title: Wolff-Parkinson-White syndrome in the era of catheter ablation: insights from a registry study of 2169 patients.
abstract: BACKGROUND
  The management of Wolff-Parkinson-White is based on the distinction between asymptomatic and symptomatic presentations, but evidence is limited in the asymptomatic population.
  
  
  RESULTS
  The Wolff-Parkinson-White registry was an 8-year prospective study of either symptomatic or asymptomatic Wolff-Parkinson-White patients referred to our Arrhythmology Department for evaluation or ablation. Inclusion criteria were a baseline electrophysiological testing with or without radiofrequency catheter ablation (RFA). Primary end points were the percentage of patients who experienced ventricular fibrillation (VF) or potentially malignant arrhythmias and risk factors. Among 2169 enrolled patients, 1001 (550 asymptomatic) did not undergo RFA (no-RFA group) and 1168 (206 asymptomatic) underwent ablation (RFA group). There were no differences in clinical and electrophysiological characteristics between the 2 groups except for symptoms. In the no-RFA group, VF occurred in 1.5% of patients, virtually exclusively (13 of 15) in children (median age, 11 years), and was associated with a short accessory pathway antegrade refractory period (P<0.001) and atrioventricular reentrant tachycardia initiating atrial fibrillation (P<0.001) but not symptoms. In the RFA group, ablation was successful in 98.5%, and after RFA, no patients developed malignant arrhythmias or VF over the 8-year follow-up. Untreated patients were more likely to experience malignant arrhythmias and VF (log-rank P<0.001). Time-dependent receiver-operating characteristic curves for predicting VF identified an optimal anterograde effective refractory period of the accessory pathway cutoff of 240 milliseconds.
  
  
  CONCLUSIONS
  The prognosis of the Wolff-Parkinson-White syndrome essentially depends on intrinsic electrophysiological properties of AP rather than on symptoms. RFA performed during the same procedure after electrophysiological testing is of benefit in improving the long-term outcomes.
authors: From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.). cpappone@gvmnet.it.
authors: Carlo
authors: C
authors: Pappone
authors: From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.).
authors: Gabriele
authors: G
authors: Vicedomini
authors: From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.).
authors: Francesco
authors: F
authors: Manguso
authors: From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.).
authors: Massimo
authors: M
authors: Saviano
authors: From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.).
authors: Mario
authors: M
authors: Baldi
authors: From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.).
authors: Alessia
authors: A
authors: Pappone
authors: From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.).
authors: Cristiano
authors: C
authors: Ciaccio
authors: From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.).
authors: Luigi
authors: L
authors: Giannelli
authors: From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.).
authors: Bogdan
authors: B
authors: Ionescu
authors: From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.).
authors: Andrea
authors: A
authors: Petretta
authors: From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.).
authors: Raffaele
authors: R
authors: Vitale
authors: From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.).
authors: Amarild
authors: A
authors: Cuko
authors: From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.).
authors: Zarko
authors: Z
authors: Calovic
authors: From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.).
authors: Angelica
authors: A
authors: Fundaliotis
authors: From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.).
authors: Mario
authors: M
authors: Moscatiello
authors: From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.).
authors: Luigi
authors: L
authors: Tavazzi
authors: From the Department of Arrhythmology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy (C.P., G.V., F.M., M.S., M.B., A.P., C.C., L.G., B.I., A.P., R.V., A.C., Z.C., M.M., L.T., V.S.); and Clinical Cardiology, Università del Piemonte A. Avogadro, Novara, Italy (A.F.).
authors: Vincenzo
authors: V
authors: Santinelli
mesh_terms: D058606:Accessory Atrioventricular Bundle / Q000503:physiopathology*; D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D017115:Catheter Ablation; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000453:epidemiology; D014927:Wolff-Parkinson-White Syndrome / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D055815:Young Adult
keywords: Wolff-Parkinson-White syndrome; death, sudden; ventricular fibrillation