Pappone WPW
A Randomised Study of Prophylactic Catheter Ablation in Asymptomatic Patients with the Wolff-Parkinson-White Syndrome
Doente / População Intervenção / Exposição Comparação Desfecho
In 72 asymptomatic patients with a Wolff-Parkinson-White pattern judged high-risk on electrophysiological testing, prophylactic radiofrequency ablation of the accessory pathway markedly reduced arrhythmic events over 5 years compared with no treatment.
N
72
Desenho
Open-label RCT with 5-year follow-up
Desfecho
Arrhythmic events over 5 years
Relevância
3
ResultadoFive-year event incidence 7 % vs 77 % (p<0.001); relative risk 0.08 (95 % CI 0.02–0.33). One control patient presented with ventricular fibrillation.
Pappone C, Santinelli V, Manguso F, et al. N Engl J Med. 2003;349(19):1803-1811. 10.1056/NEJMoa035345
Discussão e crítica
Small, single-centre and unblinded, and its 77 % control event rate far exceeds any registry of asymptomatic pre-excitation — the invasive electrophysiological screen selected an extreme-risk subgroup. That is precisely why the guideline recommends an EP study to stratify risk and ablation only in those found to be high-risk, rather than ablating every delta wave.