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Original Articles

Asymptomatic Ventricular Preexcitation

A Long-Term Prospective Follow-Up Study of 293 Adult Patients

Vincenzo Santinelli, MD; Andrea Radinovic, MD; Francesco Manguso, MD; Gabriele Vicedomini, MD; Giuseppe Ciconte, MD; Simone Gulletta, MD; Gabriele Paglino, MD; Stefania Sacchi, MD; Simone Sala, MD; Cristiano Ciaccio, MD and Carlo Pappone, MD

From the Department of Arrhythmology, Electrophysiology, and Cardiac Pacing Unit, San Raffaele Scientific Institute, Milan, Italy.

Correspondence to Vincenzo Santinelli, MD, Department of Electrophysiology, San Raffaele University Hospital, Via Olgettina 60, 20132, Milan, Italy. E-mail vincenzo.santinelli{at}hsr.it

Received October 10, 2008; accepted January 27, 2009.

Background— Sudden cardiac death can be the first clinical presentation of asymptomatic ventricular preexcitation.

Methods and Results— From 1995 to 2005, we prospectively collected clinical and electrophysiological data among 293 adults with asymptomatic ventricular preexcitation (61.4% males; median age, 36 years; interquartile range [IQR], 28 to 47.5). After electrophysiological testing, patients were prospectively followed, taking no drugs. The primary end point of the study was the occurrence of a first arrhythmic event. Predictors of arrhythmic events were analyzed by univariate and multivariate Cox models. Over a median follow-up of 67 months (minimum to maximum, 8 to 90), after electrophysiological testing, 262 patients (median age, 37 years; IQR, 30 to 48) did not experience arrhythmic events, remaining totally asymptomatic, whereas 31 patients (median age, 25 years; IQR, 22 to 29; median follow-up, 27 months; minimum to maximum, 8 to 55) had a first arrhythmic event, which was potentially life-threatening in 17 of them (median age, 24 years; IQR, 20 to 28.5; median follow-up, 25 months; minimum to maximum, 9 to 55). Potentially life-threatening tachyarrhythmias resulted in resuscitated cardiac arrest (1 patient), presyncope (7 patients) syncope (4 patients), or dizziness (5 patients). In multivariate analysis age (P=0.004), inducibility (P=0.001) and anterograde effective refractory period of the accessory pathway 250 ms (P=0.001) predicted potentially life-threatening arrhythmias.

Conclusions— These results indicate that prognosis of adults who present with asymptomatic ventricular preexcitation is good, and the risk of a significant event is small. Short anterograde effective refractory period of the accessory pathway and inducibility at baseline are independent predictors of potentially life-threatening arrhythmic events, and the risk decreases with increasing age.

Key Words: Wolff-Parkinson-White syndrome • death, sudden • syncope • catheter ablation

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CLINICAL PERSPECTIVE

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