Key Points
- To identify electrophysiological predictors of potentially fatal paroxysmal atrial fibrillation in patients with an asymptomatic Wolff-Parkinson-White pattern.
- Evaluated 145 patients with manifest Wolff-Parkinson-White syndrome: 32 with paroxysmal atrial fibrillation, 49 with AV reciprocating tachycardia alone, and 64 without prior tachyarrhythmia.
- Assessed a comparison cohort of 102 patients with and without Wolff-Parkinson-White syndrome (36 with paroxysmal atrial fibrillation and 66 without).
- Performed programmed atrial stimulation to measure the shortest preexcited R-R interval, antegrade effective refractory period of the accessory pathway, repetitive atrial firing, and fragmented atrial activity.
- Among 32 patients with paroxysmal atrial fibrillation, 8 had both a shortest preexcited R-R interval <200 msec and an accessory pathway refractory period <250 msec; 7 experienced syncope or dizziness and 2 died suddenly during follow-up.
- Out of 64 asymptomatic patients with Wolff-Parkinson-White pattern, 21 (32.8%) exhibited an antegrade accessory pathway effective refractory period <250 msec.
- Programmed atrial stimulation induced a higher rate of repetitive atrial firing and fragmented atrial activity in patients with paroxysmal atrial fibrillation than in those without.
Structured PICO
Can electrophysiological parameters predict fatal paroxysmal atrial fibrillation in patients with asymptomatic Wolff-Parkinson-White pattern?
PPopulationPatients with manifest Wolff-Parkinson-White (WPW) syndrome (n=145) and a mixed group of patients with and without WPW syndrome (n=102)
IInterventionElectrophysiological study with programmed atrial stimulation
CComparatorPatients without paroxysmal atrial fibrillation or with different electrophysiological characteristics
OOutcomePrediction of fatal paroxysmal atrial fibrillation (ventricular fibrillation or sudden death)hard clinical
Electrophysiological parameters, specifically a short preexcited R-R interval (<200 msec) and short antegrade effective refractory period of the accessory pathway (<250 msec), may identify WPW patients at high risk for fatal arrhythmias.