Usefulness of invasive electrophysiologic testing to stratify the risk of arrhythmic events in asymptomatic patients with Wolff-Parkinson-White pattern (original) (raw)
Related papers
The Asymptomatic Patient with the Wolff-Parkinson-White Electrocardiogram
Pace-pacing and Clinical Electrophysiology, 1997
Sudden death can be the first manifestation of the Wolff-Parkinson-White (WPW) syndrome. The underlying mechanism being atrial fibrillation with a very high ventricular rate, because of a short anterograde refractory period of the accessory atrioventricular pathway (AP), deteriorating into ventricular fibrillation. Information on the anterograde refractory period of the AP is therefore important to recognize asymptomatic people with the WPW ECG at risk for dying suddenly. Several noninvasive tests are available to identify the low risk patient. Decision making when to interrupt the AP in asymptomatic WPW patients not at low risk requires an invasive study to document the electrophysiological properties of the AP and to determine its exact location.
Clinical and Demographic Characteristics of WPW Syndrome Attending Arrhythmia Clinic of NICVD
Bangladesh Medical Journal, 2014
Wolff-Parkinson-White syndrome is a disorder characterized by presence of an accessory pathway which predisposes patients to tachyarrhythmias and sudden death. Among patients with WPW syndrome, atrioventricular reentrant tachycardia (AVRT) is the most common arrhythmia, accounting for 95% of re-entrant tachycardias. It has been estimated that one-third of patients with WPW syndrome have atrial fibrillation (AF). AF is a potentially life-threatening arrhythmia. If an accessory pathway has a short anterograde refractory period, then rapid repetitive conduction to the ventricles during AF can result in a rapid ventricular response with subsequent degeneration to ventricular fibrillation (VF). The study population included a total of 255 patients in whom 175 (68.62%) were men and 80 (31.38%) were women. Demographic data and clinical characteristics are depicted in Table 1. Left and right WPW syndrome were existing in 70.59% and 29.41% of patients respectively. Documented narrow QRS SVT ...
The American Journal of Cardiology, 1983
Twenty patients with the Wolff-Parkinson-White (WPW) syndrome and 1 or more episodes of symptomatic atrial fibrillation (AF) due to rapid anterograde bypass tract conduction underwent electrophysiologic testing. The mean ventricular rate during spontaneous AF was 242 f 56 beats/min (f standard deviation) and the shortest preexcited R-R interval was 194 f 40 ms. Six patients underwent surgical bypass tract ablation and 14 were treated medically, based on the results of electropharmacologic testing. Over a mean follow-up period of 35 f 19 months (f standard deviation), only 1 patient treated medically had a recurrence of minimally symptomatic AF. The successful chemoprophylaxis of symptomatic AF was associated with the inability to induce AF and atrioventricular reciprocating tachycardia during drug testing (7 patients) or with the induction of AF with a ventricular rate <200 beats/min and a shortest preexcited R-R interval of >250 ms (7 patients). Electrophysiologic testing can identify a subgroup of patients with WPW and AF in whom medical therapy is a suitable alternative to bypass tract ablation. Patients with the Wolff-Parkinson-White syndrome (WPW) who have an episode of atria1 fibrillation (AF) may have an extremely rapid ventricular rate due to rapid conduction through an atrioventricular bypass tract. In addition to causing symptoms due to hemodynamic compromise, such as syncope or weakness, the rapid ventricular rate that occurs during AF may also result in ventricular fibrillation.'p2 One option available for the treatment of patients with WPW who have had an episode of AF associated with an extremely rapid ventricular rate is surgical ablation of the bypass tract." This therapeutic option exposes the patient to the potential risks of open-heart surgery. Few data are available regarding the long-term results of medical therapy in patients with WPW and AF. We therefore examined the role of electrophysiologic testing in selecting patients with WPW and AF who may be appropriate candidates for medical therapy and in designing a drug regimen effective in preventing life-threatening episodes of AF.
Relation Between clinical presentation and induced arrhythmias in the Wolff-Parkinson-White syndrome
American Journal of Cardiology, 1987
Electrophysiologic testing is warranted in patients with the Wolff-Parkinson-White (WPW) syndrome presenting with rapid atrial fibrillation (AF) or ventricular fibrillation. Indications are less clear in patients presenting only with atrioventricular reentrant tachycardia (ART). A knowledge of propensity of this latter group to show a rapid ventricular response in the event of AF and the ability of electrophysiologic testing to reproduce the type and rate of clinical arrhythmias are relevant to this decision. The records of 126 symptomatic patients with manifest WPW syndrome were reviewed and separated into 4 groups according to presentation: group l-AF; group P-ART; group 3-palpitations suggesting ART; and group 4-AF and ART. All patients except those in group 3 had electrocardiographically documented clinical arrhythmias, and these arrhythmias were compared with those induced during electrophysiologic testing. The shortest RR interval during induced AF and the cycle length of induced ART correlated well with those occurring clinically (r = 0.72, p <O.OOOOl), as did the cycle length of induced ART (r = 0.79, p <O.OOOOl). Patients presenting with AF (65% ) had a higher incidence of atrial vulnerability (46%) and sustained AF at electrophysiologic testing than those presenting with ART (16 % and 5 % ) or undocumented palpitations (27 % and 21% ). Forty-one percent of patients with ART and 51% with undocumented palpitations had potentially lethal rates (shortest RR interval <250 ms) during induced AF. The ability to reproduce clinical arrhythmias and the frequency of rapid rates during AF induced in patients presenting with only ART or undocumented palpitations supports the recommendation for electrophysiologic testing in symptomatic patients with WPW. (Am J Cardiol 1967;60:576-579) T here is general agreement that therapy guided by electrophysiologic testing is indicated in patients with Wolff-Parkinson-White (WPW] syndrome who present with atria1 fibrillation (AF] and a rapid ventricular response over the accessory pathway.1 It is less clear whether electrophysiologic testing is necessary in patients with anterograde preexcitation presenting with well tolerated atrioventricular reentrant tachycardia (ART] or undocumented palpitations suggestive of ART. Knowledge of the propensity of the latter groups to have a rapid ventricular response to AF may be helpful in addressing this issue. We compared the electrophysiologic properties of the accessory pathway in patients presenting with ART or with undocument-