Impact of catheter ablation in asymptomatic patients with pre-excitation syndrome - real world evidence

Q: What are the key findings of this study?

Catheter ablation was associated with a 75% reduction in all-cause mortality (HR 0.25) compared to conservative management in asymptomatic patients with pre-excitation syndrome.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Asymptomatic pre-excitation syndrome (n=5852). Intervention: Catheter ablation vs. Conservative management (medical therapy). Primary outcome: All-cause mortality (HR 0.25, 95% CI 0.13-0.48, p=<0.001).

Q: What does this research mean for the field?

Catheter ablation in asymptomatic patients with pre-excitation syndrome is associated with significantly reduced risks of all-cause mortality, heart failure onset, and hospitalizations compared to conservative medical management. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate long-term clinical outcomes of catheter ablation compared with conservative medical management in asymptomatic patients with pre-excitation syndrome using real-world clinical data.

Maximilian Moersdorf; Christian Massad; Mohammad Montaser Atasi; Yara Menassa; Han Feng; Michel Abou‐Khalil; A Darzi; Carlo Khoury; Qussay Marashly; Rodolfo Montiel; Philipp Sommer; Amitabh C. Pandey; Christian Sohns; Nassir Marrouche

doi:10.1007/s10840-026-02385-9

July 28, 2026Journal of Interventional Cardiac ElectrophysiologyOpen Access

Impact of catheter ablation in asymptomatic patients with pre-excitation syndrome - real world evidence

View Full Paper

Ask AI

Bookmark

Share

Key result

Catheter ablation linked to ~75% lower all-cause mortality vs. conservative management in asymptomatic pre-excitation.

HR 0.25
95% CI 0.13-0.48
P<0.001
n=5,852

Why the study?

While symptomatic patients with pre-excitation syndromes undergo ablation, the optimal management of asymptomatic individuals remains debated.

Does catheter ablation reduce all-cause mortality in asymptomatic patients with pre-excitation syndrome compared to conservative management?

Key Points

To evaluate long-term clinical outcomes of catheter ablation compared with conservative medical management in asymptomatic patients with pre-excitation syndrome using real-world clinical data.
Retrospective observational cohort study using the TriNetX U.S. Collaborative Network identifying patients aged 12 to 50 years with asymptomatic pre-excitation between September 1, 2010, and October 1, 2024.
1:1 propensity score matching generated a final sample of 5,852 patients comparing catheter ablation versus conservative management across up to 10 years of follow-up (mean follow-up: 1133 ± 1166 days).
Catheter ablation was associated with a significant reduction in the primary outcome of all-cause mortality (HR 0.25, 95% CI: 0.13–0.48, p < 0.001).
Ablation significantly lowered rates of new-onset heart failure (HR 0.48, 95% CI: 0.26–0.85, p = 0.011) and all-cause hospitalization (HR 0.47, 95% CI: 0.37–0.60, p < 0.001).
No statistically significant differences were observed for new-onset ventricular tachycardia/fibrillation (HR 0.85, 95% CI: 0.51–1.43, p = 0.534), atrial fibrillation (HR 1.61, 95% CI: 1.00–2.62, p = 0.051), or syncope (HR 1.50, 95% CI: 0.78–2.91, p = 0.224).

Study Design

Type

Cohort (n=5,852)

Multicenter

Yes

Structured PICO

Does catheter ablation reduce all-cause mortality in asymptomatic patients with pre-excitation syndrome compared to conservative management?

P

Population

5,852 propensity-matched patients aged 12 to 50 years with asymptomatic pre-excitation syndrome, followed for a mean of 1,133 days.

E

Exposure

Catheter ablation

C

Comparator

Conservative management / medical therapy (guideline-directed medical therapy)

O

Outcome

All-cause mortality up to 10 years of follow-uphard clinical

Main Result

Hazard Ratio: 0.25 (95% CI 0.13–0.48)

p-value: p=<0.001

In asymptomatic patients with pre-excitation syndrome, catheter ablation is associated with significantly reduced long-term all-cause mortality and new-onset heart failure compared to conservative management.

Limitations

Retrospective observational design susceptible to selection bias and unmeasured confounders.
Imbalances in QRS duration, QTc interval, heart rate, and glomerular filtration rate remained despite propensity matching.
Dependent on administrative coding accuracy, which may lead to misclassification of asymptomatic status.
Lack of detailed procedural information, such as pathway localization, acute success, and complications.
Cause-specific mortality data was not available.
Retrospective observational design susceptible to selection bias and unmeasured confounders
Residual imbalance in QRS duration, QTc interval, heart rate, and glomerular filtration rate despite propensity matching
Reliance on administrative coding which may introduce misclassification
Lack of detailed procedural information such as pathway localization, acute success, and complications
Cause-specific mortality was not available

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

May support ablation consideration in asymptomatic pre-excitation; leaves open randomized confirmation of mortality benefit.

Abstract

BACKGROUND: Pre-excitation syndromes such as Wolff-Parkinson-White increase risks of tachyarrhythmias and sudden cardiac death. While symptomatic patients undergo ablation, optimal management of asymptomatic individuals remains debated. This study aims to evaluate long-term outcomes of catheter ablation versus conservative management in asymptomatic patients utilizing real-world data. METHODS: In this observational cohort study using the U.S. Collaborative Network in TriNetX, patients ≥ 12 to 50 years with asymptomatic pre-excitation between September 1, 2010 and October 1, 2024 were identified. After 1:1 propensity score matching, 5,852 patients were included. The primary endpoint was all-cause mortality. Secondary endpoints included hospitalization, syncope, new onset of heart failure (HF), ventricular tachycardia/fibrillation (VT/VF), atrial fibrillation (AF) and antiarrhythmic drug (AAD) use up to 10 years of follow-up. Outcomes were compared between patients undergoing ablation versus those receiving medical therapy (GDMT). RESULTS: Over a mean follow-up of 1133 ± 1166 days, ablation was associated with reduced risks of the all-cause mortality (hazard ratio (HR) 0.25, 95%CI:0.13-0.48, p < 0.001), HF onset (HR 0.48, 95%CI:0.26-0.85, p = 0.011) and hospitalization rates (HR 0.47, 95%CI:0.37-0.60, p < 0.001). No significant differences were observed for new onset of VT/VF (HR 0.85, 95%CI:0.51-1.43, p = 0.534), AF (HR 1.61, 95%CI:1.00-2.62, p = 0.051) and syncope (HR 1.50, 95%CI:0.78-2.91, p = 0.224). CONCLUSION: In asymptomatic patients with pre-excitation, catheter ablation was associated with a reduced mortality, fewer hospitalizations, and HF onset. These findings support considering ablation as a proactive strategy in selected asymptomatic individuals.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Moersdorf et al. (2026) conducted a cohort in Asymptomatic pre-excitation syndrome (n=5,852). Catheter ablation vs. Conservative management (medical therapy) was evaluated on All-cause mortality (HR 0.25, 95% CI 0.13-0.48, p=<0.001). Catheter ablation was associated with a 75% reduction in all-cause mortality (HR 0.25) compared to conservative management in asymptomatic patients with pre-excitation syndrome.

synapsesocial.com/papers/6a6af50460e2b924d3ea0935 https://doi.org/10.1007/s10840-026-02385-9

View Full Paper

Ask AI

Bookmark

Share

Impact of catheter ablation in asymptomatic patients with pre-excitation syndrome - real world evidence

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Impact of catheter ablation in asymptomatic patients with pre-excitation syndrome - real world evidence

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading