Catheter Ablation of Wolff-Parkinson White Syndrome: 14-YEAR Trends in Utilization and Complications in the United States (original) (raw)
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Wolff-Parkinson-White Syndrome in the Era of Catheter Ablation
Circulation, 2014
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. Methods and 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% ...
Catheter ablation in an 80-year-old male with late-onset Wolff-Parkinson-White syndrome
Case Reports in Internal Medicine, 2016
Wolff-Parkinson-White syndrome is a congenital condition involving abnormal conductive cardiac tissue between atria and ventricles, that provides a pathway for a re-entrant tachycardia circuit or rapid repetitive ventricular response during atrial fibrillation. Clinical onset is usually from childhood to middle age, and symptoms vary in severity from palpitations (with or without syncope) to cardiac arrest. Presentation varies depending on the patient's age and presence of comorbidities, as arrhythmias are less tolerated in case of an associated heart disease. In individuals who do not experience symptoms, the condition may go unnoticed for years. We describe the case of an 80-year-old Caucasian male with late-onset of Wolff-Parkinson-White syndrome. He presented with a regular, hemodynamically unstable wide-complex tachycardia with left bundle branch morphology, successfully treated with medical therapy. After recurrence of tachycardia, he underwent an electrophysiological study that showed an orthodromic atrioventricular re-entrant tachycardia using a posterolateral accessory pathway and with functional left bundle branch block. Transseptal radiofrequency catheter ablation of the accessory pathway was successfully performed. After 15 months of follow-up, there was no tachycardia recurrence or findings of pre-excitation on the electrocardiogram. The treatment of both supraventricular and ventricular arrhythmias may be challenging especially in elderly patients. Catheter ablation of left accessory pathways with transseptal approach is feasible and effective in old patients with late-onset Wolff-Parkinson-White syndrome.
New England Journal of Medicine, 2003
Young age and inducibility of atrioventricular reciprocating tachycardia or atrial fibrillation during invasive electrophysiological testing identify asymptomatic patients with a Wolff-Parkinson-White pattern on the electrocardiogram as being at high risk for arrhythmic events. We tested the hypothesis that prophylactic catheter ablation of accessory pathways would provide meaningful and durable benefits as compared with no treatment in such patients. methods From 1997 to 2002, among 224 eligible asymptomatic patients with the Wolff-Parkinson-White syndrome, patients at high risk for arrhythmias were randomly assigned to radio-frequency catheter ablation of accessory pathways (37 patients) or no treatment (35 patients). The end point was the occurrence of arrhythmic events over a five-year follow-up period. results Patients assigned to ablation had base-line characteristics that were similar to those of the controls. Two patients in the ablation group (5 percent) and 21 in the control group (60 percent) had arrhythmic events. One control patient had ventricular fibrillation as the presenting arrhythmia. The five-year Kaplan-Meier estimates of the incidence of arrhythmic events were 7 percent among patients who underwent ablation and 77 percent among the controls (P<0.001 by the log-rank test); the risk reduction with ablation was 92 percent (relative risk, 0.08; 95 percent confidence interval, 0.02 to 0.33; P<0.001). conclusions Prophylactic accessory-pathway ablation markedly reduces the frequency of arrhythmic events in asymptomatic patients with the Wolff-Parkinson-White syndrome who are at high risk for such events.
Circulation: Arrhythmia and Electrophysiology, 2015
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. Methods and 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 ...
The American Journal of Cardiology, 1994
Percutaneous ablation of accessory pathways was performed in 22 consecutive children and adolescents (9 boys and 13 girls, age range 8 to 18 years). Low-energy direct current (DC) was used exclusively in the first 6 patients, whereas ablation was performed with radiofrequency energy in the following 16. Accessory pathways were located in the left free wall in 15 patients, were posteroseptal in 3, were in the right free wall in 3 and were anteroseptal in 1. A concealed accessory pathway was present in 7 patients (32%). There was no significant difference in clinical or electrophysiologic variables between both groups. Catheter ablation was successful in the initial 6 patients using low-energy DC, as compared with 13 of 16 patients using radiofrequency ablation. Low-energy DC was successful as a backup power source in all 3 patients who had unsuccessful radiofrequency ablation. There was no complication. The median procedural and fluoroscopic times for successful ablation were 2.5 hours and 49 minutes, respectively (p = NS between both power sources). Accessory pathway conduction recurred in 2 patients (33%) who had low-energy DC as compared with 1 (6%) who had radiofrequency ablation (p = NS). These 3 patients had successful reablation of their accessory pathways. In children and adolescents with accessory pathways, both new power sources compare favorably, with an overall success rate of ablation of 100% (22 of 22 patients). Radiofrequency ablation should be used initially because it does not require general anesthesia and is associated with a lower rate of recurrence of accessory pathway conduction.(ABSTRACT TRUNCATED AT 250 WORDS)