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. Commentary
Identifieur interne : 000905 ( PascalFrancis/Checkpoint ); précédent : 000904; suivant : 000906Usefulness 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. Commentary
Auteurs : Carlo Pappone [Italie] ; Vincenzo Santinelli [Italie] ; Salvatore Rosanio [Italie] ; Gabriele Vicedomini [Italie] ; Stefano Nardi [Italie] ; Alessia Pappone [Italie] ; Valter Tortoriello [Italie] ; Francesco Manguso [Italie] ; Patrizio Mazzone [Italie] ; Simone Gulletta [Italie] ; Giuseppe Oreto [Italie] ; Ottavio Alfieri [Canada] ; Derick M. Todd [Canada] ; George J. Klein [Canada] ; Andrew D. Krahn [Canada] ; Allan C. Skanes [Canada] ; Raymond Yee [Canada]Source :
- Journal of the American College of Cardiology [ 0735-1097 ] ; 2003.
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Abstract
OBJECTIVES The aim of this study was to assess in a large cohort of asymptomatic subjects with Wolff-Parkinson-White (WPW) pattern the usefulness of invasive electrophysiologic testing (EPT) in predicting the occurrence of arrhythmic events over a five-year follow-up. BACKGROUND Sudden death may be the first clinical manifestation of the WPW syndrome in previously asymptomatic patients. Serial EPTs have been proposed to identify patients at risk. METHODS A total of 212 consecutive asymptomatic WPW patients were enrolled after a baseline EPT; patients were followed for five years, and 162 patients (115 noninducible and 47 inducible) patients underwent a second EPT. RESULTS After a mean follow-up of 37.7 months, 33 patients became symptomatic. Of the 115 noninducible patients, 18.2% lost anterograde accessory pathway (AP) conduction, 30% retrograde AP conduction, and only 4 (3.4%) developed symptomatic supraventricular tachycardia (SVT). Of the 47 inducible patients, 25 with sustained atrioventricular reciprocating tachycardia (AVRT) and atrial fibrillation (AF), and 4 with nonsustained AVRT and AF became symptomatic for SVT (n = 21) and AF (n = 8). They were younger, had shorter AP anterograde refractory periods, and multiple APs compared to patients who remained asymptomatic (for all comparisons, p < 0.0001). Of the eight patients with symptomatic episodes of AF and inducible sustained AF, two had a resuscitated cardiac arrest and one died suddenly; all three patients were inducible for AVRT and AF and had multiple APs. CONCLUSIONS In asymptomatic WPW subjects, EPT may be a valuable tool to stratify the risk of symptomatic and fatal arrhythmic events.
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Commentary</title><author><name sortKey="Pappone, Carlo" sort="Pappone, Carlo" uniqKey="Pappone C" first="Carlo" last="Pappone">Carlo Pappone</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Cardiology, Electrophysiology, and Cardiac Pacing Unit, San Raffaele University Hospital</s1><s2>Milan</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Santinelli, Vincenzo" sort="Santinelli, Vincenzo" uniqKey="Santinelli V" first="Vincenzo" last="Santinelli">Vincenzo Santinelli</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Cardiology, Electrophysiology, and Cardiac Pacing Unit, San Raffaele University Hospital</s1><s2>Milan</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Rosanio, Salvatore" sort="Rosanio, Salvatore" uniqKey="Rosanio S" first="Salvatore" last="Rosanio">Salvatore Rosanio</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Cardiology, Electrophysiology, and Cardiac Pacing Unit, San Raffaele University Hospital</s1><s2>Milan</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region 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University Hospital</s1><s2>Milan</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Pappone, Alessia" sort="Pappone, Alessia" uniqKey="Pappone A" first="Alessia" last="Pappone">Alessia Pappone</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Cardiology, Electrophysiology, and Cardiac Pacing Unit, San Raffaele University Hospital</s1><s2>Milan</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region 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Hospital</s1><s2>Milan</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Alfieri, Ottavio" sort="Alfieri, Ottavio" uniqKey="Alfieri O" first="Ottavio" last="Alfieri">Ottavio Alfieri</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of Western Ontario</s1><s2>London, Ontario</s2><s3>CAN</s3><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>University of Western Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Todd, Derick M" sort="Todd, Derick M" uniqKey="Todd D" first="Derick M." last="Todd">Derick M. Todd</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of Western Ontario</s1><s2>London, Ontario</s2><s3>CAN</s3><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>University of Western Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Klein, George J" sort="Klein, George J" uniqKey="Klein G" first="George J." last="Klein">George J. Klein</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of Western Ontario</s1><s2>London, Ontario</s2><s3>CAN</s3><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>University of Western Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Krahn, Andrew D" sort="Krahn, Andrew D" uniqKey="Krahn A" first="Andrew D." last="Krahn">Andrew D. Krahn</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of Western Ontario</s1><s2>London, Ontario</s2><s3>CAN</s3><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>University of Western Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Skanes, Allan C" sort="Skanes, Allan C" uniqKey="Skanes A" first="Allan C." last="Skanes">Allan C. Skanes</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of Western Ontario</s1><s2>London, Ontario</s2><s3>CAN</s3><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>University of Western Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Yee, Raymond" sort="Yee, Raymond" uniqKey="Yee R" first="Raymond" last="Yee">Raymond Yee</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of Western Ontario</s1><s2>London, Ontario</s2><s3>CAN</s3><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>University of Western Ontario</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">03-0109954</idno><date when="2003">2003</date><idno type="stanalyst">PASCAL 03-0109954 INIST</idno><idno type="RBID">Pascal:03-0109954</idno><idno type="wicri:Area/PascalFrancis/Corpus">000B38</idno><idno type="wicri:Area/PascalFrancis/Curation">000185</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000905</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">000905</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">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. Commentary</title><author><name sortKey="Pappone, Carlo" sort="Pappone, Carlo" uniqKey="Pappone C" first="Carlo" last="Pappone">Carlo Pappone</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Cardiology, Electrophysiology, and Cardiac Pacing Unit, San Raffaele University Hospital</s1><s2>Milan</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Santinelli, Vincenzo" sort="Santinelli, Vincenzo" uniqKey="Santinelli V" first="Vincenzo" last="Santinelli">Vincenzo Santinelli</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Cardiology, Electrophysiology, and Cardiac Pacing Unit, San Raffaele University Hospital</s1><s2>Milan</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Rosanio, Salvatore" sort="Rosanio, Salvatore" uniqKey="Rosanio S" first="Salvatore" last="Rosanio">Salvatore Rosanio</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Cardiology, Electrophysiology, and Cardiac Pacing Unit, San Raffaele University Hospital</s1><s2>Milan</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Vicedomini, Gabriele" sort="Vicedomini, Gabriele" uniqKey="Vicedomini G" first="Gabriele" last="Vicedomini">Gabriele Vicedomini</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Cardiology, Electrophysiology, and Cardiac Pacing Unit, San Raffaele University Hospital</s1><s2>Milan</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Nardi, Stefano" sort="Nardi, Stefano" uniqKey="Nardi S" first="Stefano" last="Nardi">Stefano Nardi</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Cardiology, Electrophysiology, and Cardiac Pacing Unit, San Raffaele University Hospital</s1><s2>Milan</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Pappone, Alessia" sort="Pappone, Alessia" uniqKey="Pappone A" first="Alessia" last="Pappone">Alessia Pappone</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Cardiology, Electrophysiology, and Cardiac Pacing Unit, San Raffaele University Hospital</s1><s2>Milan</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Tortoriello, Valter" sort="Tortoriello, Valter" uniqKey="Tortoriello V" first="Valter" last="Tortoriello">Valter Tortoriello</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Cardiology, Electrophysiology, and Cardiac Pacing Unit, San Raffaele University Hospital</s1><s2>Milan</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Manguso, Francesco" sort="Manguso, Francesco" uniqKey="Manguso F" first="Francesco" last="Manguso">Francesco Manguso</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Cardiology, Electrophysiology, and Cardiac Pacing Unit, San Raffaele University Hospital</s1><s2>Milan</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Mazzone, Patrizio" sort="Mazzone, Patrizio" uniqKey="Mazzone P" first="Patrizio" last="Mazzone">Patrizio Mazzone</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Cardiology, Electrophysiology, and Cardiac Pacing Unit, San Raffaele University Hospital</s1><s2>Milan</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Gulletta, Simone" sort="Gulletta, Simone" uniqKey="Gulletta S" first="Simone" last="Gulletta">Simone Gulletta</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Cardiology, Electrophysiology, and Cardiac Pacing Unit, San Raffaele University Hospital</s1><s2>Milan</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Oreto, Giuseppe" sort="Oreto, Giuseppe" uniqKey="Oreto G" first="Giuseppe" last="Oreto">Giuseppe Oreto</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Cardiology, Electrophysiology, and Cardiac Pacing Unit, San Raffaele University Hospital</s1><s2>Milan</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Alfieri, Ottavio" sort="Alfieri, Ottavio" uniqKey="Alfieri O" first="Ottavio" last="Alfieri">Ottavio Alfieri</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of Western Ontario</s1><s2>London, Ontario</s2><s3>CAN</s3><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>University of Western Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Todd, Derick M" sort="Todd, Derick M" uniqKey="Todd D" first="Derick M." last="Todd">Derick M. Todd</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of Western Ontario</s1><s2>London, Ontario</s2><s3>CAN</s3><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>University of Western Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Klein, George J" sort="Klein, George J" uniqKey="Klein G" first="George J." last="Klein">George J. Klein</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of Western Ontario</s1><s2>London, Ontario</s2><s3>CAN</s3><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>University of Western Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Krahn, Andrew D" sort="Krahn, Andrew D" uniqKey="Krahn A" first="Andrew D." last="Krahn">Andrew D. Krahn</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of Western Ontario</s1><s2>London, Ontario</s2><s3>CAN</s3><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>University of Western Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Skanes, Allan C" sort="Skanes, Allan C" uniqKey="Skanes A" first="Allan C." last="Skanes">Allan C. Skanes</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of Western Ontario</s1><s2>London, Ontario</s2><s3>CAN</s3><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>University of Western Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Yee, Raymond" sort="Yee, Raymond" uniqKey="Yee R" first="Raymond" last="Yee">Raymond Yee</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>University of Western Ontario</s1><s2>London, Ontario</s2><s3>CAN</s3><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>University of Western Ontario</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">Journal of the American College of Cardiology</title><title level="j" type="abbreviated">J. Am. Coll. Cardiol.</title><idno type="ISSN">0735-1097</idno><imprint><date when="2003">2003</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Journal of the American College of Cardiology</title><title level="j" type="abbreviated">J. Am. Coll. Cardiol.</title><idno type="ISSN">0735-1097</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Arrhythmia</term><term>Asymptomatic</term><term>Complication</term><term>Electrophysiology</term><term>Exploration</term><term>Human</term><term>Morbidity</term><term>Prognosis</term><term>Risk analysis</term><term>Technique</term><term>Wolff Parkinson White syndrome</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Wolff Parkinson White syndrome</term><term>Homme</term><term>Analyse risque</term><term>Electrophysiologie</term><term>Exploration</term><term>Technique</term><term>Asymptomatique</term><term>Trouble rythme cardiaque</term><term>Complication</term><term>Pronostic</term><term>Morbidité</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">OBJECTIVES The aim of this study was to assess in a large cohort of asymptomatic subjects with Wolff-Parkinson-White (WPW) pattern the usefulness of invasive electrophysiologic testing (EPT) in predicting the occurrence of arrhythmic events over a five-year follow-up. BACKGROUND Sudden death may be the first clinical manifestation of the WPW syndrome in previously asymptomatic patients. Serial EPTs have been proposed to identify patients at risk. METHODS A total of 212 consecutive asymptomatic WPW patients were enrolled after a baseline EPT; patients were followed for five years, and 162 patients (115 noninducible and 47 inducible) patients underwent a second EPT. RESULTS After a mean follow-up of 37.7 months, 33 patients became symptomatic. Of the 115 noninducible patients, 18.2% lost anterograde accessory pathway (AP) conduction, 30% retrograde AP conduction, and only 4 (3.4%) developed symptomatic supraventricular tachycardia (SVT). Of the 47 inducible patients, 25 with sustained atrioventricular reciprocating tachycardia (AVRT) and atrial fibrillation (AF), and 4 with nonsustained AVRT and AF became symptomatic for SVT (n = 21) and AF (n = 8). They were younger, had shorter AP anterograde refractory periods, and multiple APs compared to patients who remained asymptomatic (for all comparisons, p < 0.0001). Of the eight patients with symptomatic episodes of AF and inducible sustained AF, two had a resuscitated cardiac arrest and one died suddenly; all three patients were inducible for AVRT and AF and had multiple APs. CONCLUSIONS In asymptomatic WPW subjects, EPT may be a valuable tool to stratify the risk of symptomatic and fatal arrhythmic events.</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0735-1097</s0></fA01><fA02 i1="01"><s0>JACCDI</s0></fA02><fA03 i2="1"><s0>J. Am. Coll. Cardiol.</s0></fA03><fA05><s2>41</s2></fA05><fA06><s2>2</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>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. Commentary</s1></fA08><fA11 i1="01" i2="1"><s1>PAPPONE (Carlo)</s1></fA11><fA11 i1="02" i2="1"><s1>SANTINELLI (Vincenzo)</s1></fA11><fA11 i1="03" i2="1"><s1>ROSANIO (Salvatore)</s1></fA11><fA11 i1="04" i2="1"><s1>VICEDOMINI (Gabriele)</s1></fA11><fA11 i1="05" i2="1"><s1>NARDI (Stefano)</s1></fA11><fA11 i1="06" i2="1"><s1>PAPPONE (Alessia)</s1></fA11><fA11 i1="07" i2="1"><s1>TORTORIELLO (Valter)</s1></fA11><fA11 i1="08" i2="1"><s1>MANGUSO (Francesco)</s1></fA11><fA11 i1="09" i2="1"><s1>MAZZONE (Patrizio)</s1></fA11><fA11 i1="10" i2="1"><s1>GULLETTA (Simone)</s1></fA11><fA11 i1="11" i2="1"><s1>ORETO (Giuseppe)</s1></fA11><fA11 i1="12" i2="1"><s1>ALFIERI (Ottavio)</s1></fA11><fA11 i1="13" i2="1"><s1>TODD (Derick M.)</s1><s9>comment.</s9></fA11><fA11 i1="14" i2="1"><s1>KLEIN (George J.)</s1><s9>comment.</s9></fA11><fA11 i1="15" i2="1"><s1>KRAHN (Andrew D.)</s1><s9>comment.</s9></fA11><fA11 i1="16" i2="1"><s1>SKANES (Allan C.)</s1><s9>comment.</s9></fA11><fA11 i1="17" i2="1"><s1>YEE (Raymond)</s1><s9>comment.</s9></fA11><fA14 i1="01"><s1>Department of Cardiology, Electrophysiology, and Cardiac Pacing Unit, San Raffaele University Hospital</s1><s2>Milan</s2><s3>ITA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></fA14><fA14 i1="02"><s1>University of Western Ontario</s1><s2>London, Ontario</s2><s3>CAN</s3><sZ>12 aut.</sZ><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ><sZ>16 aut.</sZ><sZ>17 aut.</sZ></fA14><fA20><s1>239-248</s1></fA20><fA21><s1>2003</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>20098</s2><s5>354000103689350100</s5></fA43><fA44><s0>0000</s0><s1>© 2003 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>42 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>03-0109954</s0></fA47><fA60><s1>P</s1><s3>AR</s3><s3>CT</s3></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>Journal of the American College of Cardiology</s0></fA64><fA66 i1="01"><s0>USA</s0></fA66><fC01 i1="01" l="ENG"><s0>OBJECTIVES The aim of this study was to assess in a large cohort of asymptomatic subjects with Wolff-Parkinson-White (WPW) pattern the usefulness of invasive electrophysiologic testing (EPT) in predicting the occurrence of arrhythmic events over a five-year follow-up. BACKGROUND Sudden death may be the first clinical manifestation of the WPW syndrome in previously asymptomatic patients. Serial EPTs have been proposed to identify patients at risk. METHODS A total of 212 consecutive asymptomatic WPW patients were enrolled after a baseline EPT; patients were followed for five years, and 162 patients (115 noninducible and 47 inducible) patients underwent a second EPT. RESULTS After a mean follow-up of 37.7 months, 33 patients became symptomatic. Of the 115 noninducible patients, 18.2% lost anterograde accessory pathway (AP) conduction, 30% retrograde AP conduction, and only 4 (3.4%) developed symptomatic supraventricular tachycardia (SVT). Of the 47 inducible patients, 25 with sustained atrioventricular reciprocating tachycardia (AVRT) and atrial fibrillation (AF), and 4 with nonsustained AVRT and AF became symptomatic for SVT (n = 21) and AF (n = 8). They were younger, had shorter AP anterograde refractory periods, and multiple APs compared to patients who remained asymptomatic (for all comparisons, p < 0.0001). Of the eight patients with symptomatic episodes of AF and inducible sustained AF, two had a resuscitated cardiac arrest and one died suddenly; all three patients were inducible for AVRT and AF and had multiple APs. CONCLUSIONS In asymptomatic WPW subjects, EPT may be a valuable tool to stratify the risk of symptomatic and fatal arrhythmic events.</s0></fC01><fC02 i1="01" i2="X"><s0>002B24D01</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Wolff Parkinson White syndrome</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Wolff Parkinson White syndrome</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Wolff Parkinson White síndrome</s0><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Homme</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Human</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Hombre</s0><s5>02</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Analyse risque</s0><s5>03</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Risk analysis</s0><s5>03</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Análisis riesgo</s0><s5>03</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Electrophysiologie</s0><s5>04</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>Electrophysiology</s0><s5>04</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Electrofisiología</s0><s5>04</s5></fC03><fC03 i1="05" i2="X" l="FRE"><s0>Exploration</s0><s5>05</s5></fC03><fC03 i1="05" i2="X" l="ENG"><s0>Exploration</s0><s5>05</s5></fC03><fC03 i1="05" i2="X" l="SPA"><s0>Exploración</s0><s5>05</s5></fC03><fC03 i1="06" i2="X" l="FRE"><s0>Technique</s0><s5>06</s5></fC03><fC03 i1="06" i2="X" l="ENG"><s0>Technique</s0><s5>06</s5></fC03><fC03 i1="06" i2="X" l="SPA"><s0>Técnica</s0><s5>06</s5></fC03><fC03 i1="07" i2="X" l="FRE"><s0>Asymptomatique</s0><s5>07</s5></fC03><fC03 i1="07" i2="X" l="ENG"><s0>Asymptomatic</s0><s5>07</s5></fC03><fC03 i1="07" i2="X" l="SPA"><s0>Asintomático</s0><s5>07</s5></fC03><fC03 i1="08" i2="X" l="FRE"><s0>Trouble rythme cardiaque</s0><s5>08</s5></fC03><fC03 i1="08" i2="X" l="ENG"><s0>Arrhythmia</s0><s5>08</s5></fC03><fC03 i1="08" i2="X" l="SPA"><s0>Arritmia</s0><s5>08</s5></fC03><fC03 i1="09" i2="X" l="FRE"><s0>Complication</s0><s5>09</s5></fC03><fC03 i1="09" i2="X" l="ENG"><s0>Complication</s0><s5>09</s5></fC03><fC03 i1="09" i2="X" l="SPA"><s0>Complicación</s0><s5>09</s5></fC03><fC03 i1="10" i2="X" l="FRE"><s0>Pronostic</s0><s5>10</s5></fC03><fC03 i1="10" i2="X" l="ENG"><s0>Prognosis</s0><s5>10</s5></fC03><fC03 i1="10" i2="X" l="SPA"><s0>Pronóstico</s0><s5>10</s5></fC03><fC03 i1="11" i2="X" l="FRE"><s0>Morbidité</s0><s5>11</s5></fC03><fC03 i1="11" i2="X" l="ENG"><s0>Morbidity</s0><s5>11</s5></fC03><fC03 i1="11" i2="X" l="SPA"><s0>Morbilidad</s0><s5>11</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Appareil circulatoire pathologie</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Cardiovascular disease</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Aparato circulatorio patología</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Cardiopathie</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Heart disease</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Cardiopatía</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Trouble excitabilité</s0><s5>40</s5></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Excitability disorder</s0><s5>40</s5></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Trastorno excitabilidad</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="FRE"><s0>Trouble conduction</s0><s5>41</s5></fC07><fC07 i1="04" i2="X" l="ENG"><s0>Conduction disorder</s0><s5>41</s5></fC07><fC07 i1="04" i2="X" l="SPA"><s0>Trastorno conducción</s0><s5>41</s5></fC07><fC07 i1="05" i2="X" l="FRE"><s0>Préexcitation ventriculaire syndrome</s0><s5>42</s5></fC07><fC07 i1="05" i2="X" l="ENG"><s0>Preexcitation ventricular syndrome</s0><s5>42</s5></fC07><fC07 i1="05" i2="X" l="SPA"><s0>Preexcitación ventricular síndrome</s0><s5>42</s5></fC07><fN21><s1>062</s1></fN21><fN82><s1>PSI</s1></fN82></pA></standard></inist><affiliations><list><country><li>Canada</li><li>Italie</li></country><region><li>Lombardie</li></region><settlement><li>Milan</li></settlement></list><tree><country name="Italie"><region name="Lombardie"><name sortKey="Pappone, Carlo" sort="Pappone, Carlo" uniqKey="Pappone C" first="Carlo" last="Pappone">Carlo Pappone</name></region><name sortKey="Gulletta, Simone" sort="Gulletta, Simone" uniqKey="Gulletta S" first="Simone" last="Gulletta">Simone Gulletta</name><name sortKey="Manguso, Francesco" sort="Manguso, Francesco" uniqKey="Manguso F" first="Francesco" last="Manguso">Francesco Manguso</name><name sortKey="Mazzone, Patrizio" sort="Mazzone, Patrizio" uniqKey="Mazzone P" first="Patrizio" last="Mazzone">Patrizio Mazzone</name><name sortKey="Nardi, Stefano" sort="Nardi, Stefano" uniqKey="Nardi S" first="Stefano" last="Nardi">Stefano Nardi</name><name sortKey="Oreto, Giuseppe" sort="Oreto, Giuseppe" uniqKey="Oreto G" first="Giuseppe" last="Oreto">Giuseppe Oreto</name><name sortKey="Pappone, Alessia" sort="Pappone, Alessia" uniqKey="Pappone A" first="Alessia" last="Pappone">Alessia Pappone</name><name sortKey="Rosanio, Salvatore" sort="Rosanio, Salvatore" uniqKey="Rosanio S" first="Salvatore" last="Rosanio">Salvatore Rosanio</name><name sortKey="Santinelli, Vincenzo" sort="Santinelli, Vincenzo" uniqKey="Santinelli V" first="Vincenzo" last="Santinelli">Vincenzo Santinelli</name><name sortKey="Tortoriello, Valter" sort="Tortoriello, Valter" uniqKey="Tortoriello V" first="Valter" last="Tortoriello">Valter Tortoriello</name><name sortKey="Vicedomini, Gabriele" sort="Vicedomini, Gabriele" uniqKey="Vicedomini G" first="Gabriele" last="Vicedomini">Gabriele Vicedomini</name></country><country name="Canada"><noRegion><name sortKey="Alfieri, Ottavio" sort="Alfieri, Ottavio" uniqKey="Alfieri O" first="Ottavio" last="Alfieri">Ottavio Alfieri</name></noRegion><name sortKey="Klein, George J" sort="Klein, George J" uniqKey="Klein G" first="George J." last="Klein">George J. Klein</name><name sortKey="Krahn, Andrew D" sort="Krahn, Andrew D" uniqKey="Krahn A" first="Andrew D." last="Krahn">Andrew D. Krahn</name><name sortKey="Skanes, Allan C" sort="Skanes, Allan C" uniqKey="Skanes A" first="Allan C." last="Skanes">Allan C. Skanes</name><name sortKey="Todd, Derick M" sort="Todd, Derick M" uniqKey="Todd D" first="Derick M." last="Todd">Derick M. Todd</name><name sortKey="Yee, Raymond" sort="Yee, Raymond" uniqKey="Yee R" first="Raymond" last="Yee">Raymond Yee</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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