25 years prospective electrophysiological follow-up study of 260 Wolff-Parkinson-White patients with transesophageal electrophysiologic testing (TEEPT)

To assess the prognostic value of TEEPT for risk-assessment and follow-up (F-up) of WPW patients (pts). Methods: 260 pts, 150 symptomatic (S) (tachycardia 89%, syncope 7.9%; or both 15.%), enrolled. TEEPT performed at rest and under effort. AVNode and Accessory Pathway(AP) antegrade effective refractory periods (ERP) at 3 pacing cycles (PCL:600,400,320ms), inducibility of AVRT/AF and shortest preexcited RR interval during AF (SRRaf) and/or pacing (SRRp) were assessed. Results: median F-up was 12.7±7.8years (3291 patient-years). APERP and SRRaf varied with posture and PCL, significantly shorter in S versus asymptomatic(AS) pts at rest (p< 0.01 and p< 0.05 respectively), but not under effort. SVT inducible in 48% of AS, 78% of S (p<0.05). 55 pts were placed on drugs after first TEEPT (35 of them underwent ablation, which failed in 4. 2 of them, both identified as mandatory candidates to ablation on the basis of TEEPT (SRRaf <180 msec at rest) died suddenly at rest (mortality (0.08% per year of F-up). Conclusions: TEEPT’s results highly reproducible in untreated pts. Reliable alternative to invasive EPS for risk stratification and F-up of WPW pts.