Long-Term Natural History of Adult Wolff-Parkinson-White Syndrome Patients Treated With and Without Catheter Ablation.
BACKGROUND
There are a paucity of data about the long-term natural history of adult Wolff-Parkinson-White syndrome (WPW) patients in regard to risk of mortality and atrial fibrillation. We sought to describe the long-term outcomes of WPW patients and ascertain the impact of ablation on the natural history.


RESULTS
Three groups of patients were studied: 2 WPW populations (ablation: 872, no ablation: 1461) and a 1:5 control population (n=11 175). Long-term mortality and atrial fibrillation rates were determined. The average follow-up for the WPW group was 7.9±5.9 (median: 6.9) years and was similar between the ablation and nonablation groups. Death rates were similar between the WPW group versus the control group (hazard ratio, 0.96; 95% confidence interval, 0.83-1.11; P=0.56). Nonablated WPW patients had a higher long-term death risk compared with ablated WPW patients (hazard ratio, 2.10; 95% confidence interval: 1.50-20.93; P<0.0001). Incident atrial fibrillation risk was higher in the WPW group compared with the control population (hazard ratio, 1.55; 95% confidence interval, 1.29-1.87; P<0.0001). Nonablated WPW patients had lower risk than ablated patients (hazard ratio, 0.39; 95% confidence interval, 0.28-0.53; P<0.0001).


CONCLUSIONS
Long-term mortality rates in WPW patients are low and similar to an age-matched and gender-matched control population. WPW patients that underwent the multifactorial process of ablation had a lower mortality compared to nonablated WPW patients. Atrial fibrillation rates are high long-term, and ablation does not reduce this risk.
From the Department of Cardiology, Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B., H.T.M., T.L.B., J.L.A., B.G.C., M.J.C., V.J., C.M., J.B.M., J.S.O., J.P.W., J.D.D.); and Department of Internal Medicine, Stanford University, Palo Alto, CA (T.J.B.). thomas.bunch@imail.org.
T Jared
TJ
Bunch
From the Department of Cardiology, Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B., H.T.M., T.L.B., J.L.A., B.G.C., M.J.C., V.J., C.M., J.B.M., J.S.O., J.P.W., J.D.D.); and Department of Internal Medicine, Stanford University, Palo Alto, CA (T.J.B.).
Heidi T
HT
May
From the Department of Cardiology, Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B., H.T.M., T.L.B., J.L.A., B.G.C., M.J.C., V.J., C.M., J.B.M., J.S.O., J.P.W., J.D.D.); and Department of Internal Medicine, Stanford University, Palo Alto, CA (T.J.B.).
Tami L
TL
Bair
From the Department of Cardiology, Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B., H.T.M., T.L.B., J.L.A., B.G.C., M.J.C., V.J., C.M., J.B.M., J.S.O., J.P.W., J.D.D.); and Department of Internal Medicine, Stanford University, Palo Alto, CA (T.J.B.).
Jeffrey L
JL
Anderson
From the Department of Cardiology, Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B., H.T.M., T.L.B., J.L.A., B.G.C., M.J.C., V.J., C.M., J.B.M., J.S.O., J.P.W., J.D.D.); and Department of Internal Medicine, Stanford University, Palo Alto, CA (T.J.B.).
Brian G
BG
Crandall
From the Department of Cardiology, Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B., H.T.M., T.L.B., J.L.A., B.G.C., M.J.C., V.J., C.M., J.B.M., J.S.O., J.P.W., J.D.D.); and Department of Internal Medicine, Stanford University, Palo Alto, CA (T.J.B.).
Michael J
MJ
Cutler
From the Department of Cardiology, Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B., H.T.M., T.L.B., J.L.A., B.G.C., M.J.C., V.J., C.M., J.B.M., J.S.O., J.P.W., J.D.D.); and Department of Internal Medicine, Stanford University, Palo Alto, CA (T.J.B.).
Victoria
V
Jacobs
From the Department of Cardiology, Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B., H.T.M., T.L.B., J.L.A., B.G.C., M.J.C., V.J., C.M., J.B.M., J.S.O., J.P.W., J.D.D.); and Department of Internal Medicine, Stanford University, Palo Alto, CA (T.J.B.).
Charles
C
Mallender
From the Department of Cardiology, Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B., H.T.M., T.L.B., J.L.A., B.G.C., M.J.C., V.J., C.M., J.B.M., J.S.O., J.P.W., J.D.D.); and Department of Internal Medicine, Stanford University, Palo Alto, CA (T.J.B.).
Joseph B
JB
Muhlestein
From the Department of Cardiology, Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B., H.T.M., T.L.B., J.L.A., B.G.C., M.J.C., V.J., C.M., J.B.M., J.S.O., J.P.W., J.D.D.); and Department of Internal Medicine, Stanford University, Palo Alto, CA (T.J.B.).
Jeffrey S
JS
Osborn
From the Department of Cardiology, Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B., H.T.M., T.L.B., J.L.A., B.G.C., M.J.C., V.J., C.M., J.B.M., J.S.O., J.P.W., J.D.D.); and Department of Internal Medicine, Stanford University, Palo Alto, CA (T.J.B.).
J Peter
JP
Weiss
From the Department of Cardiology, Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT (T.J.B., H.T.M., T.L.B., J.L.A., B.G.C., M.J.C., V.J., C.M., J.B.M., J.S.O., J.P.W., J.D.D.); and Department of Internal Medicine, Stanford University, Palo Alto, CA (T.J.B.).
John D
JD
Day
D000328:Adult; D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology; D017115:Catheter Ablation; D005260:Female; D006801:Humans; D007061:Idaho / Q000453:epidemiology; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014589:Utah / Q000453:epidemiology; D014927:Wolff-Parkinson-White Syndrome / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult
Wolff-Parkinson-White syndrome; adult; atrial fibrillation; catheter ablation; mortality