Open AccessAsymptomatic Ventricular Pre-excitation: Between Sudden Cardiac Death and Catheter Ablation
Author(s) -
Josép Brugada,
Roberto Keegan
Publication year - 2018
Publication title -
arrhythmia and electrophysiology review
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.008
H-Index - 18
eISSN - 2050-3377
pISSN - 2050-3369
DOI - 10.15420/aer.2017.51.2
Subject(s) - medicine , asymptomatic , catheter ablation , cardiology , ventricular tachycardia , atrial fibrillation , ablation , sudden cardiac death , accessory pathway , catheter , ventricular fibrillation , surgery
Debate about the best clinical approach to the management of asymptomatic patients with ventricular pre-excitation and advice on whether or not to invasively stratify and ablate is on-going. Weak evidence about the real risk of sudden cardiac death and the potential benefit of catheter ablation has probably prevented the clarification of action in this not infrequent and sometimes conflicting clinical situation. After analysing all available data, real evidence-based medicine could be the alternative strategy for managing this group of patients. According to recent surveys, most electrophysiologists invasively stratify. Based on all accepted risk factors – younger age, male, associated structural heart disease, posteroseptal localisation, ability of the accessory pathway to conduct anterogradely at short intervals of ≤250 milliseconds and inducibility of sustained atrioventricular re-entrant tachycardia and/or atrial fibrillation – a shared decisionmaking process on catheter ablation is proposed.