title: Invasive electrophysiological evaluation and ablation in patients with asymptomatic ventricular pre-excitation persistent at exercise stress test.
abstract: OBJECTIVE
  In patients with asymptomatic ventricular pre-excitation (VPE) persistent at exercise stress test, this study evaluates the proportion of cases with adverse conduction properties of the atrioventricular accessory pathway (AP) at invasive electrophysiological study and the long-term follow-up after they received treatment according to pre-determined criteria.
  
  
  RESULTS
  Over 10 years, asymptomatic patients with VPE persistent at exercise stress test referred for invasive electrophysiological evaluation including isoproterenol (IPN) infusion were included. Ablation was planned if they had at least one of the following criteria: (i) shortest pre-excited R-R interval (SPERRI) ≤250 ms and/or (ii) inducible atrioventricular re-entrant tachycardia (AVRT). Cryoablation was electively used in para-hisian and mid-septal APs. Patients non-eligible for ablation received no therapy. Sixty-three patients (45 males; mean age 26 ± 14 years) underwent electrophysiological evaluation: 7 had fasciculo-ventricular fibres and were excluded, whereas 56 had 58 APs. Thirty-one patients (55%) were eligible and underwent successful ablation: 87% had at least the SPERRI ≤ 250 ms and 61% had at least inducible AVRT. In 15 cases (48%) the ablation criteria were met only during IPN infusion. During follow-up (73 ± 33 months), one patient was successfully retreated for resumption of VPE in the ablation group, whereas no event was observed in the group of patients who received no treatment.
  
  
  CONCLUSIONS
  In this subset of patients with asymptomatic VPE, invasive electrophysiological evaluation shows fast antegrade conduction over the AP and/or inducible AVRT in about half of the cases. Patients who received no therapy because of a benign electrophysiological profile had an event-free follow-up.
authors.affiliation: Department of Heart and Vessels, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Viale Borri, 57, Varese IT-21100, Italy rdeponti@alice.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: De Ponti
authors.affiliation: Department of Heart and Vessels, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Viale Borri, 57, Varese IT-21100, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Marazzi
authors.affiliation: Department of Heart and Vessels, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Viale Borri, 57, Varese IT-21100, Italy.
authors.forename: Lorenzo A
authors.initials: LA
authors.lastname: Doni
authors.affiliation: Department of Heart and Vessels, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Viale Borri, 57, Varese IT-21100, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Cremona
authors.affiliation: Department of Heart and Vessels, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Viale Borri, 57, Varese IT-21100, Italy.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Marazzato
authors.affiliation: Department of Heart and Vessels, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Viale Borri, 57, Varese IT-21100, Italy.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Salerno-Uriarte
mesh_terms: D058606:Accessory Atrioventricular Bundle / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D000293:Adolescent; D000318:Adrenergic beta-Agonists; D000328:Adult; D058070:Asymptomatic Diseases; D017115:Catheter Ablation / Q000379:methods; D002648:Child; D015331:Cohort Studies; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D005080:Exercise Test; D005260:Female; D006801:Humans; D007545:Isoproterenol; D008297:Male; D008875:Middle Aged; D011226:Pre-Excitation Syndromes / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D012189:Retrospective Studies; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000175:diagnosis* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000318:Adrenergic beta-Agonists; D007545:Isoproterenol
keywords: Asymptomatic Wolff–Parkinson–White electrocardiographic pattern; Catheter ablation; Electrophysiological study; Isoproterenol