Clinical and Electrocardiographic Variables Can Predict Atrial Fibrillation in Patients with Atrioventricular Accessory Pathways

Background: Risk stratification of sudden death in patients with Wolff‐Parkinson‐White syndrome is based on the refractory period of the atrioventricular accessory pathway and the probability of spontaneous atrial fibrillation. Risk stratification based on invasive studies does not seem cost‐effective in the radiofrequency ablation era, and, although sensitive, noninvasive tests are not used because of their low specificity. We sought to determine whether clinical and electrocardiographic variables can predict spontaneous atrial fibrillation in patients with an accessory pathway. Methods: We studied 420 consecutive patients treated by radiofrequency catheter ablation who had a single atrioventricular accessory pathway and the Influence of four variables: age, gender, location of the accessory pathway as determined by the site of successful radiofrequency ablation, and the presence of a manifest accessory pathway in the ECG was analyzed by multiple logistic regression analysis and a chi‐square test. The development model, comprised of data from the first 359 patients, included 58 patients with spontaneous atrial fibrillation and 301 patients without spontaneous atrial fibrillation during follow‐up. The likelihood ratio derived from the development model was validated in the last 61 patients. Results: Patients with spontaneous atrial fibrillation occurring before accessory pathway ablation were more often male and were older than those without atrial fibrillation. Atrial fibrillation occurred more frequently in manifest than in concealed accessory pathways, and the presence of posteroseptal accessory pathway strongly correlated with spontaneous atrial fibrillation. Conclusion: The probability of spontaneous atrial fibrillation was higher in men with a manifest posteroseptal accessory pathway and increased with age. A.N.E. 2000;5(1):45–52