A Brief review of the risks and the stratification of sudden death in the ventricular Pre-excitation syndrome.

Authors

  • Clovis Fröemming Junior Instituto de Cardiologia - Fundação Universidade de Cardiologia https://orcid.org/0000-0002-4770-0050
  • Tiago Luiz Luz Leiria Instituto de Cardiologia – Fundação Universitária de Cardiologia – Porto Alegre/RS – Brazil.
  • Gustavo Glotz de Lima Instituto de Cardiologia – Fundação Universitária de Cardiologia – Porto Alegre/RS – Brazil.
  • Leonardo Martins Pires Instituto de Cardiologia – Fundação Universitária de Cardiologia – Porto Alegre/RS – Brazil.
  • Marcelo Lapa Kruse Instituto de Cardiologia – Fundação Universitária de Cardiologia – Porto Alegre/RS – Brazil.
  • Thiago Camargo Moreira Instituto de Cardiologia – Fundação Universitária de Cardiologia – Porto Alegre/RS – Brazil.
  • Javier Fernando Vasquez Pinos Instituto de Cardiologia – Fundação Universitária de Cardiologia – Porto Alegre/RS – Brazil.
  • Bruno Schaaf Finkler Instituto de Cardiologia – Fundação Universitária de Cardiologia – Porto Alegre/RS – Brazil.
  • Danilo Barros Zanotta Instituto de Cardiologia – Fundação Universitária de Cardiologia – Porto Alegre/RS – Brazil.

Keywords:

Preexcitation, Accessory pathway, Wolff-Parkinson-White Syndrome

Abstract

Objective: The diagnosis of ventricular preexcitation syndromes is often occasional and with underestimated risk, showing controversies in its stratification and indication of prophylactic ablation. This work aims to explore and summarize the data in the literature, exposing the authors’ conclusions regarding this review. Methods: The authors prepared this work based on the latest guideline of the European Society of Cardiology plus a search for articles published in MEDLINE whose titles related to sudden death from ventricular fibrillation in patients with ventricular preexcitation. Discussion: Sudden death secondary to preexcited atrial fibrillation with degeneration to ventricular fibrillation is the most feared event in Wolff-Parkinson-White syndrome, has an average annual incidence of 0.15 to 0.39%, affecting individuals with structurally normal heart. The noninvasive stratification methods do not demonstrate adequate efficacy, and an electrophysiological study is recommended for all cases at the time of diagnosis. The most severe criteria for sudden death are shortest preexcited RR interval ≤ 250 ms (SPERRI or SPRRI); accessory pathway effective refractory period (APERP) ≤ 250 ms; presence of multiple accessory bundles; shortest paced cycle length with preexcitation during atrial pacing ≤ 250ms (SPPCL); Ebstein anomaly; induction of sustained supraventricular tachycardia. Conclusion: The low rate of complications during the diagnostic exam as well as in the therapeutic procedure, added to the high percentage of success of radiofrequency ablation, leads to indicate early the execution of electrophysiological study as a more diligent and accurate measure in the reduction of sudden death events in patients with ventricular preexcitation syndromes.

Downloads

Download data is not yet available.

References

Munger TM, Packer DL, Hammill SC, et al. A population study of the natural history of Wolff-Parkinson-White syndrome in Olmsted County, Minnesota, 1953–1989. Circulation 1993; 87: 866–873.

Blomstrom-Lundqvist C, Scheinman MM, Aliot EM, et al. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias – executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients with Supraventricular Arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society. J Am Coll Cardiol 2003; 42: 1493–1531.

Wolff L, White P. Bundle-branch block with short PR interval in healthy young people to paroxysmal tachycardia. Am Heart J 1930; 6: 685–704.

Burchell HB, Frye RL, Anderson MW, McGoon DC. Atrioventricular and ventriculoatrial excitation in Wolff-Parkinson- White syndrome (type B). Temporary ablation at surgery. Circulation 1967; 36: 663–672.

Klein GJ, Bashore TM, Sellers TD, Pritchett EL, Smith WM, Gallagher JJ. Ventricular fibrillation in the Wolff-Parkinson- White syndrome. N Engl J Med 1979; 301: 1080–1085.

Timmermans C, Smeets JL, Rodriguez LM, Vrouchos G, von den Dool A, Wellens HJ. Aborted sudden death in the Wolff- Parkinson-White syndrome. Am J Cardiol 1995; 76: 492–494.

Fitzsimmons PJ, McWhirter PD, Peterson DW, Kruyer WB. The natural history of Wolff-Parkinson-White syndrome in 228 military aviators: a long-term follow-up of 22 years. Am Heart J 2001; 142: 530–536.

Inoue K, Igarashi H, Fukushige J, Ohno T, Joh K, Hara T. Longterm prospective study on the natural history of Wolff-Parkinson- White syndrome detected during a heart screening program at school. Acta Paediatr 2000; 89: 542–545.

Bershader RS CF. Exercise testing for risk assessment in pediatric Wolff-Parkinson-White syndrome. Heart Rhythm 2007; 4: 138–139.

Daubert C, Ollitrault J, Descaves C, Mabo P, Ritter P, Gouffault J. Failure of the exercise test to predict the anterograde refractory period of the accessory pathway in Wolff Parkinson White syndrome. Pacing Clin Electrophysiol 1988; 11: 1130–1138.

Klein GJ, Gulamhusein SS. Intermittent preexcitation in the Wolff-Parkinson-White syndrome. Am J Cardiol 1983; 52: 292–296.

Cohen MI, Triedman JK, Cannon BC, et al. PACES/HRS expert consensus statement on the management of the asymptomatic young patient with a Wolff-Parkinson-White (WPW, ventricular preexcitation) electrocardiographic pattern: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology Foundation (ACCF), the American Heart Association (AHA), the American Academy of Pediatrics (AAP), and the Canadian Heart Rhythm Society (CHRS). Heart Rhythm 2012; 9: 1006–1024.

Fitzsimmons PJ, McWhirter PD, Peterson DW, Kruyer WB. The natural history of Wolff-Parkinson-White syndrome in 228 military aviators: a long-term follow-up of 22 years. Am Heart J 2001; 142: 530–536.

Pappone C, Santinelli V, Rosanio S, Vicedomini G, Nardi S, Pappone A, Tortoriello V, Manguso F, Mazzone P, Gulletta S, Oreto G, Alfieri O. Usefulness of invasive electrophysiologic testing to stratify the risk of arrhythmic events in asymptomatic patients with Wolff-Parkinson-White pattern: results from a large prospective long-term follow-up study. J Am Coll Cardiol 41(2):239–244.

Etheridge, S. P., Escudero, C. A., Blaufox, A. D., Law, I. H., Dechert-Crooks, B. E., Stephenson, E. A., … Sanatani, S. Life-Threatening Event Risk in Children With Wolff-Parkinson-White Syndrome. JACC: Clinical Electrophysiology, 4(4), 433–444.

Kim SS, Knight BP. Long term risk of Wolff–Parkinson– White pattern and syndrome. Trends Cardiovasc Med 27(4):260– 268.

Di Mambro C, Drago F, Milioni M, Russo MS, Righi D, Placidi S, Remoli R, Palmieri R, Gimigliano F, Santucci LM, Silvetti MS, Prosperi M. Sports eligibility after risk assessment and treatment in children with asymptomatic ventricular pre-excitation. Sports Med 46(8):1183–1190.

Yıldırım I, Özer S, Karagöz T, Şahin M, Özkutlu S, Alehan D, Çeliker A. Clinical and electrophysiological evaluation of pediatric Wolff–Parkinson–White patients. Anatol J Cardiol 15(6):485–490.

Kubuš P, Vít P, Gebauer RA, Materna O, Janoušek J. Electrophysiologic profile and results of invasive risk stratification in asymptomatic children and adolescents with the Wolff–Parkinson–White electrocardiographic pattern. Circ Arrhythm Electrophysiol 7(2):218–223.

Downloads

Published

2020-07-25

How to Cite

Fröemming Junior, C., Leiria, T. L. L. ., Lima, G. G. de ., Pires, L. M. ., Kruse, M. L. ., Moreira, T. C. ., Pinos, J. F. V. ., Finkler, B. S. ., & Zanotta, D. B. . (2020). A Brief review of the risks and the stratification of sudden death in the ventricular Pre-excitation syndrome. JOURNAL OF CARDIAC ARRHYTHMIAS, 33(4). Retrieved from https://jca.org.br/jca/article/view/3400

Issue

Vol. 33 No. 4 (2020)

Section

Clinical Arrythmia

Categories