Prophylactic Ablation in Asymptomatic Patients with Wolff-Parkinson-White Syndrome

Context: Radiofrequency ablation is a highly effective and safe therapy for the management of patients with symptomatic Wolff-Parkinson-White (WPW) syndrome. However, the management of asymptomatic patients with radiofrequency ablation is controversial. This review aimed to investigate whether prophylactic ablation could improve the long-term outcomes of asymptomatic patients with WPW. Methods: A systematic literature search was performed in databases such as PubMed, Google Scholar, and Cochrane Library for the relevant articles published during 2000 - 2020. Only original studies, cohorts, and randomized controlled trials (RCTs) performed on the WPW patients undergoing radiofrequency ablation were selected. Results: In total, six studies were reviewed, some of which suggested that the patients undergoing radiofrequency ablation had a high incidence of atrial fibrillation even after ablation. On the other hand, some of the findings indicated that ablation could reduce the mortality rate of WPW patients. In addition, two RCTs suggested that prophylactic ablation may reduce arrhythmic events in high-risk pediatric and adult patients, while one clinical trial showed no significant risk reduction for arrhythmias in the patients undergoing the prophylactic radiofrequency catheter ablation of the accessory pathways. Conclusions: Available evidence suggests that prophylactic ablation is effective in the prevention of arrhythmic events and sudden cardiac death in asymptomatic patients with WPW. However, the risk of asymptomatic patients becoming symptomatic or sudden cardiac death has been reported to be low. Therefore, only high-risk patients are recommended to undergo prophylactic ablation.