Wolff-Parkinson-White Syndrome Clinical Trial
Official title:
Accessory Pathway Antegrade Effective Refractory Period Among Wolff Parkinson White Patients: the Risk in Relation to the Location
To correlate the antegrade effective refractory period of the accessory pathway with its
anatomical location in the heart.
To investigate whether the accessory pathway location can predict the high risk nature of the
accessory pathway
The Wolf-Parkinson-White (WPW) syndrome is a clinical entity characterized by the presence of
≥1 accessory pathways between the atria and the ventricles pre-disposing patients to
arrhythmias. Anterograde conduction through the accessory pathway leads to preexcitation of
the ventricles and a delta wave in the ECG. The prevalence of preexcitation in the general
population has been estimated to be 1 to 3 in 1000 individuals. Although most asymptomatic
patients with pre-excitation have a good prognosis, there is also a lifetime risk of
malignant arrhythmias and SCD, estimated to be 0.1 % per patient year.
- More worrisome is the fact that this event can be the first manifestation of the disease
in up to 53 % of patients.
- Atrial fibrillation (AF) can be a life-threatening arrhythmia in the WPW syndrome if the
AV AP has a short anterograde refractory period (RP), allowing too many atrial impulses
to be conducted to the ventricle.
- This will result in very high ventricular rates with possible deterioration into
ventricular fibrillation (VF) and sudden death.
- Parameters proved to indicate high risk AP include AP effective refractory period <240
ms, shortest preexcited RR interval <250 ms
- Certain Locations were thought to be associated with higher risk of the accessory
pathway like Septal localization which was significantly more frequent in patients with
VF when compared with individuals with no VF but the overall number of patients is
limited . .
These debatable relations between AP location and its risk stratification was not extensively
studied in larger scale studies….
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