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Europace 2008 10(2):175-180; doi:10.1093/europace/eum300
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

ACCESSORY PATHWAYS

Are the results of electrophysiological study different in patients with a pre-excitation syndrome, with and without syncope?

Béatrice Brembilla-Perrot*, Frédéric Chometon, Laurent Groben, Charif Tatar, Jean-Dominique Luporsi, Julien Bertrand, Olivier Huttin, Daniel Beurrier, Sonia Ammar, Juanico Cedano, Nacima Benzaghou, Marius Andronache, Rouzbeh Valizadeh, Arnaud Terrier De La Chaise, Pierre Louis, Olivier Selton, Olivier Claudon and François Marçon

Department of Cardiology, CHU of Brabois, 54500 Vandoeuvre, France

Aims: Syncope in Wolff–Parkinson–White (WPW) syndrome may reveal an arrhythmic event or is not WPW syndrome related. The aim of the study is to evaluate the results of electrophysiological study in WPW syndrome according to the presence or not of syncope and the possible causes of syncope.

Methods and results: Among 518 consecutive patients with diagnosis of WPW syndrome, 71 patients, mean age 34.5 ± 17, presented syncope. Transoesophageal electrophysiological study in control state and after isoproterenol infusion was performed in the out-patient clinic. Atrioventricular re-entrant tachycardia (AVRT) was more frequently induced than in asymptomatic patients (n = 38, 53.5%, P < 0.01), less frequently than in those with tachycardia; atrial fibrillation (AF) and/or antidromic tachycardia (ATD) was induced in 28 patients (39%) more frequently (P < 0.05) than in asymptomatic patients or those with tachycardia. The incidence of high-risk form [rapid conduction over accessory pathway (AP) and AF or ATD induction] was higher in syncope group (n = 18, 25%, P < 0.001) than in asymptomatic subjects (8%) or those with tachycardias (7.5%). Maximal rate conducted over AP was similar in patients with and without syncope, and higher in patients with spontaneous AF, but without syncope. Results were not age-related.

Conclusion: Tachycardia inducibility was higher in patients with syncope than in the asymptomatic group. The incidence of malignant WPW syndrome was higher in patients with syncope than in asymptomatic or symptomatic population, but the maximal rate conducted over AP was not higher and another mechanism could be also implicated in the mechanism of syncope.

Key Words: Wolff–Parkinson–White syndrome, Syncope, Electrophysiological study

* Corresponding author. Tel: +33 383153142; fax: +33 383154226.E-mail address: b.brembilla-perrot{at}chu-nancy.fr

Manuscript submitted 20 November 2007. Accepted after revision 18 December 2007.


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