Radiofrequency ablation of accessory pathways in patients with the Wolff-Parkinson-White syndrome: the long-term mortality and risk of atrial fibrillation

Rune Borregaard; Christian Gerdes; David R. Möller; Peter Mortensen; Lars Pedersen; Jens Cosedis Nielsen; Henrik Kjærulf Jensen

doi:10.1093/europace/euu176

July 10, 2014EP Europace

Radiofrequency ablation of accessory pathways in patients with the Wolff-Parkinson-White syndrome: the long-term mortality and risk of atrial fibrillation

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Why the study?

Does radiofrequency ablation for Wolff-Parkinson-White syndrome affect long-term mortality and the risk of atrial fibrillation compared to the background population?

Structured PICO

Does radiofrequency ablation for Wolff-Parkinson-White syndrome affect long-term mortality and the risk of atrial fibrillation compared to the background population?

P

Population

3,981 individuals, comprising 362 patients subjected to radiofrequency ablation for Wolff-Parkinson-White (WPW) syndrome at Aarhus University Hospital (1990-2011) and a comparison cohort of 3,619 individuals from the Danish National Board of Health Central Population Registry.

I

Intervention

Radiofrequency ablation of accessory pathways for Wolff-Parkinson-White (WPW) syndrome

C

Comparator

Background population cohort from the Danish National Board of Health Central Population Registry

O

Outcome

Long-term all-cause mortality and occurrence of post-ablation atrial fibrillationhard clinical

Patients with WPW syndrome treated with radiofrequency ablation have long-term mortality similar to the general population but remain at a significantly higher risk for developing atrial fibrillation.

Implication

Post-ablation WPW patients show mortality similar to controls; leaves open whether intensified AF monitoring improves outcomes.

Abstract

AIMS: To assess the long-term mortality and occurrence of post-ablation atrial fibrillation in patients undergoing a radiofrequency ablation for the Wolff-Parkinson-White (WPW) syndrome. METHODS AND RESULTS: A retrospective cohort study of patients (N = 362) subjected to radiofrequency ablation of the WPW syndrome at Aarhus University Hospital from 1990 to 2011. A comparison cohort (N = 3619) was generated from the Danish National Board of Health Central Population Registry. We found no significant difference in all-cause mortality when comparing the WPW group with the control group [hazard ratio (HR): 0.77 and confidence interval (CI): 0.47-1.25]. After radiofrequency ablation, the WPW group had a significantly higher risk of atrial fibrillation than the control group (HR: 4.77 and CI: 3.05-7.43). Atrial fibrillation prior to ablation (HR: 4.66 and CI: 2.09-10.41) and age over 50 years (HR: 9.79 and CI: 4.29-22.36) at the time of ablation were independent risk factors for post-ablation atrial fibrillation in the WPW group. CONCLUSION: Patients with radiofrequency ablation-treated WPW syndrome have a post-ablation mortality that is similar to the background population. The risk of atrial fibrillation remains high after radiofrequency ablation of the WPW syndrome.