Current strategy for treatment of patients with Wolff-Parkinson-White syndrome and asymptomatic preexcitation in Europe: European Heart Rhythm Association survey

Europace. 2013 May;15(5):750-3. doi: 10.1093/europace/eut094.

Abstract

The aims of this survey was to provide insight into treatment activity, the strategy of treatment, and risk stratification of patients with asymptomatic and symptomatic ventricular pre-excitation across Europe. Fifty-eight centres, members of the European Heart Rhythm Association EP research network, covering 20 countries answered the survey questions. All centres were high-volume ablation centres. A younger person with asymptomatic Wolff-Parkinson-White (WPW) pattern has a higher likelihood of being risk-stratified or receiving ablation therapy compared with an older subject. Two-thirds of centres report that they have observed a decline in the number of patients ablated for an accessory pathway during the last 10 years. Pre-excited atrial fibrillation is rarely seen. Discontinuation of a scheduled WPW ablation due to close vicinity of the accessory pathway to the AV node happens very rarely. Patients with a first episode of pre-excited atrial fibrillation would immediately be referred for catheter ablation to be performed within weeks by 80.4% of the centres. A significant proportion of responders (50.9%) would use electrical cardioversion to restore sinus rhythm in a patient with pre-excited atrial fibrillation. With respect to the choice of antiarrhythmic medication for a patient with pre-excited AF, the majority (80.0%) would choose class 1C antiarrhytmic drugs while waiting for a catheter ablation. A patient seen in the emergency room with a second episode of orthodromic atrioventricular reentry tachycardia would be referred for immediate ablation by 79.2-90.6% of centres depending on the presence of pre-excitation. The volume of paediatric ablations performed on children younger than 12 years was low (46.4%: 0 patients per year; 46.4%: 1-9 patients per year). The majority of responding centres (61-69%) report that their country lack national guidelines dealing with clinical strategies related to WPW. There is a need for national guidelines dealing with clinical strategy in patients with WPW syndrome. Older individuals with asymptomatic WPW pattern have a higher risk of not receiving risk stratification or curative therapy with ablation compared with younger patients, despite the higher risk of developing atrial fibrillation.

Publication types

  • Multicenter Study

MeSH terms

  • Anti-Arrhythmia Agents / therapeutic use*
  • Cardiac Resynchronization Therapy / statistics & numerical data*
  • Catheter Ablation / statistics & numerical data*
  • Combined Modality Therapy / statistics & numerical data
  • Europe / epidemiology
  • Female
  • Health Care Surveys
  • Humans
  • Male
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Prevalence
  • Risk Factors
  • Treatment Outcome
  • Wolff-Parkinson-White Syndrome / diagnosis
  • Wolff-Parkinson-White Syndrome / epidemiology*
  • Wolff-Parkinson-White Syndrome / therapy*

Substances

  • Anti-Arrhythmia Agents