Risk of sudden death after successful accessory atrioventricular pathway ablation in resuscitated patients with Wolff-Parkinson-White syndrome

INTRODUCTION: Cardiac arrest in patients with Wolff-Parkinson-White (WPW) syndrome can be due to ventricular fibrillation mediated by fast conduction over the accessory pathway during atrial fibrillation. However, if primary ventricular fibrillation is the reason for resuscitation, placement of an implantable cardioverter defibrillator (ICD) would be indicated. The aim of this study was to test the hypothesis that in resuscitated patients with WPW syndrome, recurrences can be prevented by sole ablation of their accessory pathways. METHODS AND RESULTS: We performed a long-term follow-up study of 48 resuscitated patients with WPW syndrome who underwent successful accessory pathway ablation as their sole primary treatment. Cardiac arrest had occurred either spontaneously in 32 patients (group A) or after intravenous administration of antiarrhythmic drugs in 16 patients (group B) and was never associated with an acute myocardial infarction or other concomitant factors. All patients had normal left ventricular function at echocardiography. A total of 56 accessory AV pathways were ablated successfully with radiofrequency current (n = 55) or during surgery (n = 1) and were located at the left free wall (n = 35), right free wall (n = 8), or septal-paraseptal region (n = 13). Follow-up 5.0+/-1.9 years after ablation (range 0.2 to 7.9) was obtained in all 48 patients. All of the patients were alive, and none had a life-threatening arrhythmia or syncope after successful ablation of their accessory pathways. CONCLUSION: In resuscitated patients with WPW syndrome who have normal left ventricular function at echocardiography and no ECG abnormalities suggesting additional electrical disease, ablation of their overt accessory pathways prevented cardiac arrest recurrences; therefore, ICD placement is generally not indicated.